Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report

Abstract Background Pancreatic juice is constantly activated by contaminated bile in patients with pancreaticobiliary maljunction (PBM). Here, we report a case of laparoscopic distal pancreatectomy for a patient with PBM and sphincterotomized papilla, resulting in fatal pancreatic fistula. Case pres...

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Autores principales:	Yoshifumi Morita, Tomohiro Akutsu, Mitsumasa Makino, Miku Obayashi, Shinya Ida, Ryuta Muraki, Ryo Kitajima, Amane Hirotsu, Makoto Takeda, Hirotoshi Kikuchi, Yoshihiro Hirmatsu, Yasushi Hamaya, Ken Sugimoto, Hiromi Kato, Matsuyuki Doi, Yukichi Tanahashi, Satoshi Goshima, Takanori Sakaguchi, Hiroya Takeuchi
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Pancreaticobiliary maljunction Distal pancreatectomy Fatal pancreatic fistula Intraductal papillary mucinous neoplasm Endoscopic sphincterotomy Surgery RD1-811
Acceso en línea:	https://doaj.org/article/c23385a41f3046b796a893518f603959
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spelling	oai:doaj.org-article:c23385a41f3046b796a893518f6039592021-11-14T12:31:49ZFatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report10.1186/s40792-021-01324-22198-7793https://doaj.org/article/c23385a41f3046b796a893518f6039592021-11-01T00:00:00Zhttps://doi.org/10.1186/s40792-021-01324-2https://doaj.org/toc/2198-7793Abstract Background Pancreatic juice is constantly activated by contaminated bile in patients with pancreaticobiliary maljunction (PBM). Here, we report a case of laparoscopic distal pancreatectomy for a patient with PBM and sphincterotomized papilla, resulting in fatal pancreatic fistula. Case presentation A 79-year-old man was diagnosed with pancreatic intraductal papillary mucinous neoplasm and common bile duct stones. Endoscopic sphincterotomy was performed prior to surgery. The pancreatic duct was simultaneously visualized when the contrast agent was injected into the common bile duct. Sudden bleeding was observed from the abdominal drain on postoperative day (POD) 6. Emergent stent graft placement and coil embolization were performed for bleeding from the splenic artery. On POD 9, the drainage fluid changed to yellowish in color with bile contamination. For internal drainage of the digestive fluid, endoscopic retrograde biliary tube and pancreatic drainage tube were placed. On POD 24, second emergent coil embolization was performed for bleeding from the left gastric artery. On POD 25, open abdominal drainage was performed. On POD 32, third emergent coil embolization was performed for bleeding from the gastroduodenal artery. Subsequently, remnant pancreatic resection was performed. On POD 39, massive bleeding was again observed from the abdominal drain. Emergency arterial portography revealed bleeding in the right wall of the superior mesenteric vein. The patient died of hemorrhagic shock on the same day. Conclusions The extreme risk of severe pancreatic fistula after distal pancreatectomy should be considered in patients with PBM and sphincterotomized papilla. In this extraordinary situation, surgeons should promptly decide whether to resect the remnant pancreas to prevent losing the patient.Yoshifumi MoritaTomohiro AkutsuMitsumasa MakinoMiku ObayashiShinya IdaRyuta MurakiRyo KitajimaAmane HirotsuMakoto TakedaHirotoshi KikuchiYoshihiro HirmatsuYasushi HamayaKen SugimotoHiromi KatoMatsuyuki DoiYukichi TanahashiSatoshi GoshimaTakanori SakaguchiHiroya TakeuchiSpringerOpenarticlePancreaticobiliary maljunctionDistal pancreatectomyFatal pancreatic fistulaIntraductal papillary mucinous neoplasmEndoscopic sphincterotomySurgeryRD1-811ENSurgical Case Reports, Vol 7, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pancreaticobiliary maljunction Distal pancreatectomy Fatal pancreatic fistula Intraductal papillary mucinous neoplasm Endoscopic sphincterotomy Surgery RD1-811
spellingShingle	Pancreaticobiliary maljunction Distal pancreatectomy Fatal pancreatic fistula Intraductal papillary mucinous neoplasm Endoscopic sphincterotomy Surgery RD1-811 Yoshifumi Morita Tomohiro Akutsu Mitsumasa Makino Miku Obayashi Shinya Ida Ryuta Muraki Ryo Kitajima Amane Hirotsu Makoto Takeda Hirotoshi Kikuchi Yoshihiro Hirmatsu Yasushi Hamaya Ken Sugimoto Hiromi Kato Matsuyuki Doi Yukichi Tanahashi Satoshi Goshima Takanori Sakaguchi Hiroya Takeuchi Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
description	Abstract Background Pancreatic juice is constantly activated by contaminated bile in patients with pancreaticobiliary maljunction (PBM). Here, we report a case of laparoscopic distal pancreatectomy for a patient with PBM and sphincterotomized papilla, resulting in fatal pancreatic fistula. Case presentation A 79-year-old man was diagnosed with pancreatic intraductal papillary mucinous neoplasm and common bile duct stones. Endoscopic sphincterotomy was performed prior to surgery. The pancreatic duct was simultaneously visualized when the contrast agent was injected into the common bile duct. Sudden bleeding was observed from the abdominal drain on postoperative day (POD) 6. Emergent stent graft placement and coil embolization were performed for bleeding from the splenic artery. On POD 9, the drainage fluid changed to yellowish in color with bile contamination. For internal drainage of the digestive fluid, endoscopic retrograde biliary tube and pancreatic drainage tube were placed. On POD 24, second emergent coil embolization was performed for bleeding from the left gastric artery. On POD 25, open abdominal drainage was performed. On POD 32, third emergent coil embolization was performed for bleeding from the gastroduodenal artery. Subsequently, remnant pancreatic resection was performed. On POD 39, massive bleeding was again observed from the abdominal drain. Emergency arterial portography revealed bleeding in the right wall of the superior mesenteric vein. The patient died of hemorrhagic shock on the same day. Conclusions The extreme risk of severe pancreatic fistula after distal pancreatectomy should be considered in patients with PBM and sphincterotomized papilla. In this extraordinary situation, surgeons should promptly decide whether to resect the remnant pancreas to prevent losing the patient.
format	article
author	Yoshifumi Morita Tomohiro Akutsu Mitsumasa Makino Miku Obayashi Shinya Ida Ryuta Muraki Ryo Kitajima Amane Hirotsu Makoto Takeda Hirotoshi Kikuchi Yoshihiro Hirmatsu Yasushi Hamaya Ken Sugimoto Hiromi Kato Matsuyuki Doi Yukichi Tanahashi Satoshi Goshima Takanori Sakaguchi Hiroya Takeuchi
author_facet	Yoshifumi Morita Tomohiro Akutsu Mitsumasa Makino Miku Obayashi Shinya Ida Ryuta Muraki Ryo Kitajima Amane Hirotsu Makoto Takeda Hirotoshi Kikuchi Yoshihiro Hirmatsu Yasushi Hamaya Ken Sugimoto Hiromi Kato Matsuyuki Doi Yukichi Tanahashi Satoshi Goshima Takanori Sakaguchi Hiroya Takeuchi
author_sort	Yoshifumi Morita
title	Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
title_short	Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
title_full	Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
title_fullStr	Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
title_full_unstemmed	Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
title_sort	fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/c23385a41f3046b796a893518f603959
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Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report

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