Korean J Radiol.  2016 Oct;17(5):797-800. 10.3348/kjr.2016.17.5.797.

Percutaneous Pancreatic Stent Placement for Postoperative Pancreaticojejunostomy Stenosis: A Case Report

• Yang SK
• Yoon CJ

• KMID: 2458073
• DOI: http://doi.org/10.3348/kjr.2016.17.5.797

Abstract

Stenosis of the pancreatico-enteric anastomosis is one of the major complications of pancreaticoduodenectomy (PD). Endoscopic stent placement, has limited success rate as a nonsurgical treatment due to altered gastrointestinal anatomy. Percutaneous treatment is rarely attempted due to the technical difficulty in accessing the pancreatic duct. We reported a case of pancreaticojejunostomy stenosis after PD, in which a pancreatic stent was successfully placed using a rendezvous technique with a dual percutaneous approach.

Keyword

Pancreaticojejunostomy; Anastomotic stenosis; Acute pancreatitis; Stent placement

MeSH Terms

Acute Disease
Adolescent
Constriction, Pathologic/diagnostic imaging/etiology/surgery
Female
Humans
Pancreatic Ducts/diagnostic imaging/*surgery
Pancreaticoduodenectomy/*adverse effects
Pancreaticojejunostomy/*adverse effects
Pancreatitis/diagnostic imaging/etiology/surgery
Radiography
*Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 17-year-old patient with recurrent acute pancreatitis after PD. A. Contrast enhanced CT shows typical features of acute pancreatitis. Note diffuse swelling of remnant pancreas (white arrows) and peripancreatic fluid collection (black arrows). B. MRCP image shows diffuse mild dilatation of pancreatic duct (arrow) and focal stenosis at pancreaticojejunostomy (arrowhead). MRCP = magnetic resonance cholangiopancreatography, PD = pancreaticoduodenectomy

• 

  Fig. 2 Radiographic images obtained during pancreatic stent placement. A. Under fluoroscopy and US guidance, proximal part of pancreatic duct was punctured with 21 G needle (arrow). B. 0.014" guidewire was advanced into jejunum across stenotic PJ (white arrow), which was captured with snare catheter (black arrow). C. Balloon catheter (4 mm in diameter and 4 cm in length, white arrow) was introduced from transhepatic access, and inflated to dilate PJ stenosis. Note focal waist of balloon (black arrow). D. After exchange of guidewire, 7 Fr plastic stent (arrows) was placed to cover the stenosis. PJ = pancreaticojejunostomy, US = ultrasonography

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  Fig. 3 3-year follow-up CT shows complete resolution of previous pancreatitis (arrows).

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