Abstract
We report on a case of a 58-year-old man who had undergone a pancreaticoduodenectomy for cholangiocarcinoma 5 years previously. The patient had undergone periodic surveillance examination with no evidence of recurrence detected until recently. He had, however, suffered repeated attacks of acute pancreatitis seven times over the previous five years. We employed endoscopic retrograde cholangio-pancreatography (ERCP) using a double-balloon endoscope, as an anastomotic stricture was suspected based on the diagnostic imaging. With this approach, the anastomotic stricture was visualized and after dilation of the anastomosis using a tapered catheter, a 7 Fr plastic stent was inserted and left in the main pancreatic duct. Two months later, he had acute pancreatitis again, because the pancreatic stent had dropped. We therefore tried balloon dilatation once more and reinserted a pancreatic stent. With a followup period of about 1 year, no recurrence of the acute pancreatitis has been noted. We suggest that double-balloon endoscopy and treatment using balloon dilatation is a useful option for the management of anastomotic stricture formation after pancreaticoduodenectomy.
