A Case of Effective Trans–papillary Drainage for an Intraabdominal Abscess After a Central Pancreatectomy

Abstract

Although percutaneous or trans–gastric drainage is often adopted for the treatment of an intraabdominal abscess derived from pancreatic fistula after pancreatectomy, it is sometimes difficult to perform. A case of effective trans–papillary drainage for intraabdominal abscess is presented herein, and we discuss the effectiveness of the trans–papillary drainage. The patient was a 77–year–old male who underwent a central pancreatectomy for a solitary metastatic pancreatic tumor from renal cell carcinoma. He was discharged on the 8th postoperative day. However, he was re–admitted to our hospital on the 14th postoperative day for appetite loss, and the CT findings showed an intraabdominal abscess derived from a pancreatic fistula around the pancreatic head stump. Percutaneous or trans–gastric drainage was difficult to perform because the abscess was not adjacent to the abdominal wall or stomach. Therefore, endoscopic retrograde pancreatography was performed and an external drainage tube was inserted into the abscess through the main pancreatic duct via the duodenal papilla. The drainage tube was obstructed by a viscous discharge several times, but it was resolved by inserting an internal drainage tube in combination with the external one. The patient was discharged home on the 85th postoperative day.