Delayed Pancreatic Fistula After Pancreaticoduodenectomy. A Case Report

  • Yasuhiro Ito Department of Surgery, Saiseikai Yokohamashi Tobu Hospital. Kanagawa, Japan
  • Tomoyuki Irino Department of Surgery, Saiseikai Yokohamashi Tobu Hospital. Kanagawa, Japan
  • Tomohisa Egawa Department of Surgery, Saiseikai Yokohamashi Tobu Hospital. Kanagawa, Japan
  • Shinobu Hayashi Department of Surgery, Saiseikai Yokohamashi Tobu Hospital. Kanagawa, Japan
  • Atsushi Nagashima Department of Surgery, Saiseikai Yokohamashi Tobu Hospital. Kanagawa, Japan
Keywords: Pancreatic Fistula, Postoperative Complications, Pancreaticoduodenectomy


Context Pancreatic fistulas still occur despite refinements in both surgical technique and perioperative management after a pancreaticoduodenectomy. However, the occurrence of delayed pancreatic fistulas is very rare. Case report A 62-year-old woman diagnosed with a lower biliary carcinoma had undergone a pylorus-preserving pancreaticoduodenectomy. The postoperative course was uneventful and the patient was discharged from the hospital after 16 days. One year after surgery, she was admitted to our hospital with a fluid collection around the pancreaticojejunal anastomosis. A catheter was inserted percutaneously and the fluid collection was drained. The amylase value of the discharge was significantly elevated (119,500 IU/L). One week later, a fistulography showed no significant collection and the tube was clamped. The patient was discharged from the hospital without symptoms. Conclusions It is important to consider the occurrence of a delayed pancreatic fistula if the patient suffers from any symptoms. It is then necessary to proceed rapidly.

Image: Fistulography showing the disappearance of the fluid collection around the pancreaticojejunal anastomosis.


Download data is not yet available.


Lowy AM, Lee JE, Pisters PW, Davidson BS, Fenoglio CJ, Stanford P, et al. Prospective randomized trial of Octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Ann Surg 1997; 226:632-41. [PMID 9389397]

Roder JD, Stein HJ, Böttcher KA, Busch R, Heidecke CD, Siewert JR. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy. A prospective study. Ann Surg 1999; 229:41-8. [PMID 9923798]

Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993; 217:430-8. [PMID 8098202]

Montorsi M, Zago M, Mosca F, Capussotti L, Zotti E, Ribotta G, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resection. A prospective, controlled, randomized clinical trial. Surgery 1995; 117:26-31. [PMID 7809832]

Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995; 221:43-9. [PMID 7826160]

Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998; 228:429-38. [PMID 9742926]

Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for management. Ann Surg 1995; 222:638-45. [PMID 7487211]

van Berge Henegouwen MI, De Wit LT, Van Gulik TM, Obertop H, Gouma DJ. Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg 1997; 185:18-24. [PMID 9208956]

Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000; 232:786-95. [PMID 11088073]

Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, Shah SA. Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg 2009; 249:635-40. [PMID 19300225]

Winter JM, Cameron JL, Campbell KA, Chang DC, Riall TS, Schulick RD, et al. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 2006; 10:1280-90. [PMID 17114014]

Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007; 246:425-33. [PMID 17717446]

Tani M, Kawai M, Hirono S, Ina S, Miyazawa M, Shimizu A, Yamaue H. A prospective randomized controlled trial of internal versus external drainage with pancreaticojejunostomy for pancreaticoduodenectomy. Am J Surg 2010; 199:759-64. [PMID 20074698]

Smyrniotis V, Arkadopoulos N, Kyriazi MA, Derpapas M, Theodosopoulos T, Gennatas C, et al. Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study. Langenbecks Arch Surg 2010; 395:195-200. [PMID 20082094]

Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 2006; 244:1-7. [PMID 16794381]

Jin SG, Chen ZY, Yan LN, Zeng Y. Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy. World J Gastroenterol 2010; 16:4494-6. [PMID 20845520]

Yagmurdur MC, Gür G, Aytekin C, Karakayali H, Boyacioglu S, Bilgin N. Atypical presentation of chronic pancreatic fistula: a case successfully managed with long-acting somatostatin. Turk J Gastroenterol 2003; 14:200-3. [PMID 14655067]

Casadei R, Bassi F, Calculli L, Zanini N, Greco VM, Minni F. Report of three cases of chronic pancreatic fistulas treated with prolamine as a sclerosing substance following pancreatic resection. JOP. J Pancreas (Online) 2006; 7:41-6. [PMID 16407617]

Oh YS, Edmundowicz SA, Jonnalagadda SS, Azar RR. Pancreaticopleural fistula: report of two cases and review of the literature. Dig Dis Sci 2006; 51:1-6. [PMID 16416200]

Alexakis N, Sutton R, Neoptolemos JP. Surgical treatment of pancreatic fistula. Dig Surg 2004; 21:262-74. [PMID 15308865]

Barreto G, D'Souza MA, Shukla PJ, Shrikhande SV. The gray zone between postpancreaticoduodenectomy collections and pancreatic fistula. Pancreas 2008;37:422-5. [PMID 18953256]

Fistulography showing the disappearance of the fluid collection around the pancreaticojejunal anastomosis
How to Cite
ItoY., IrinoT., EgawaT., HayashiS., & NagashimaA. (2011). Delayed Pancreatic Fistula After Pancreaticoduodenectomy. A Case Report. JOP. Journal of the Pancreas, 12(4), 410-412.