A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report
Abstract Background Although endoscopic interventions for chronic pancreatitis are highly developed, surgery for severe complicated cases such as the coexistence of bile duct, duodenum, and portal vein stenosis is a challenging issue for surgeons. In such instances, pancreaticoduodenectomy could lea...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-05-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00872-3 |
| _version_ | 1818519002419298304 |
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| author | Yuka Abe Takafumi Kumamoto Gakuryu Nakayama Kentaro Miyake Yasuhiro Yabushita Yu Sawada Yuki Homma Kazuhisa Takeda Ryusei Matsuyama Itaru Endo |
| author_facet | Yuka Abe Takafumi Kumamoto Gakuryu Nakayama Kentaro Miyake Yasuhiro Yabushita Yu Sawada Yuki Homma Kazuhisa Takeda Ryusei Matsuyama Itaru Endo |
| author_sort | Yuka Abe |
| collection | DOAJ |
| description | Abstract Background Although endoscopic interventions for chronic pancreatitis are highly developed, surgery for severe complicated cases such as the coexistence of bile duct, duodenum, and portal vein stenosis is a challenging issue for surgeons. In such instances, pancreaticoduodenectomy could lead to massive intraoperative bleeding due to severe collateral veins. A surgical drainage procedure, instead of pancreatic resection, may be a reasonable and safer option in such cases, but the literature on a surgical drainage technique to resolve all obstructions of the pancreatic duct, bile duct, and duodenum at once is limited. We devised a new surgical drainage method for such cases with consideration for a possible future second surgery for newly developed pancreatic cancer because chronic pancreatitis is a well-known high-risk factor for pancreatic cancer in the long term. Here, we report this surgical procedure. Case presentation A 55-year-old man was diagnosed with alcoholic chronic pancreatitis 15 years ago. Before surgery, he underwent regular endoscopic pancreatic stenting for pancreatic ductal stenosis for 3 years. Three months before surgery, his duodenal stenosis worsened, and he was referred to our department for surgery. Preoperative imaging revealed pancreatic and bile duct stenosis, duodenal stenosis, and portal vein stenosis. To avoid intraoperative bleeding caused by the development of collateral veins, we performed a triple drainage procedure: longitudinal pancreaticojejunostomy with coring-out of the pancreatic head, hepaticojejunostomy, and gastrojejunostomy. The patient did not develop postoperative complications, and he was discharged from the hospital on postoperative day 14. For 5 years after surgery, no abdominal pain or recurrent pancreatitis was observed. Conclusion Our triple drainage procedure seems effective and minimally invasive for patients complicated with bile duct stenosis, duodenal stenosis, and portal vein stenosis. |
| first_indexed | 2024-12-11T01:17:53Z |
| format | Article |
| id | doaj.art-9bfe466aa4d945c784a15d2146301ee4 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-11T01:17:53Z |
| publishDate | 2020-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-9bfe466aa4d945c784a15d2146301ee42022-12-22T01:25:48ZengSpringerOpenSurgical Case Reports2198-77932020-05-01611810.1186/s40792-020-00872-3A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case reportYuka Abe0Takafumi Kumamoto1Gakuryu Nakayama2Kentaro Miyake3Yasuhiro Yabushita4Yu Sawada5Yuki Homma6Kazuhisa Takeda7Ryusei Matsuyama8Itaru Endo9Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City UniversityAbstract Background Although endoscopic interventions for chronic pancreatitis are highly developed, surgery for severe complicated cases such as the coexistence of bile duct, duodenum, and portal vein stenosis is a challenging issue for surgeons. In such instances, pancreaticoduodenectomy could lead to massive intraoperative bleeding due to severe collateral veins. A surgical drainage procedure, instead of pancreatic resection, may be a reasonable and safer option in such cases, but the literature on a surgical drainage technique to resolve all obstructions of the pancreatic duct, bile duct, and duodenum at once is limited. We devised a new surgical drainage method for such cases with consideration for a possible future second surgery for newly developed pancreatic cancer because chronic pancreatitis is a well-known high-risk factor for pancreatic cancer in the long term. Here, we report this surgical procedure. Case presentation A 55-year-old man was diagnosed with alcoholic chronic pancreatitis 15 years ago. Before surgery, he underwent regular endoscopic pancreatic stenting for pancreatic ductal stenosis for 3 years. Three months before surgery, his duodenal stenosis worsened, and he was referred to our department for surgery. Preoperative imaging revealed pancreatic and bile duct stenosis, duodenal stenosis, and portal vein stenosis. To avoid intraoperative bleeding caused by the development of collateral veins, we performed a triple drainage procedure: longitudinal pancreaticojejunostomy with coring-out of the pancreatic head, hepaticojejunostomy, and gastrojejunostomy. The patient did not develop postoperative complications, and he was discharged from the hospital on postoperative day 14. For 5 years after surgery, no abdominal pain or recurrent pancreatitis was observed. Conclusion Our triple drainage procedure seems effective and minimally invasive for patients complicated with bile duct stenosis, duodenal stenosis, and portal vein stenosis.http://link.springer.com/article/10.1186/s40792-020-00872-3Chronic pancreatitisSurgeryDrainage procedurePancreaticojejunostomyPancreaticoduodenectomyPortal vein stenosis |
| spellingShingle | Yuka Abe Takafumi Kumamoto Gakuryu Nakayama Kentaro Miyake Yasuhiro Yabushita Yu Sawada Yuki Homma Kazuhisa Takeda Ryusei Matsuyama Itaru Endo A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report Surgical Case Reports Chronic pancreatitis Surgery Drainage procedure Pancreaticojejunostomy Pancreaticoduodenectomy Portal vein stenosis |
| title | A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report |
| title_full | A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report |
| title_fullStr | A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report |
| title_full_unstemmed | A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report |
| title_short | A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report |
| title_sort | case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis duodenal stenosis and portal vein stenosis a case report |
| topic | Chronic pancreatitis Surgery Drainage procedure Pancreaticojejunostomy Pancreaticoduodenectomy Portal vein stenosis |
| url | http://link.springer.com/article/10.1186/s40792-020-00872-3 |
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