2020 Volume 53 Issue 8 Pages 635-642
A 51-year-old women visited our hospital for preoperative evaluation of gastric cancer. She had undergone gastrojejunostomy for a duodenal ulcer 20 years earlier in the USA, but detailed medical records were unavailable. The common bile duct and main pancreatic duct were dilated, and the lumens of these ducts were shrunk in the pancreatic head close to the papilla. However, laboratory data were normal. Distal gastrectomy was performed for gastric cancer. In laparotomy, severe scarring and contraction of the duodenal bulb were observed; therefore, we resected the duodenum under direct vision of the duodenal papilla through an incision in the anterior wall of the duodenum. Postoperatively, more than 300 ml of pancreatic juice was obtained through a drain placed for more than a week. In addition to stenosis of the common bile duct and main pancreatic duct in the pancreatic head, the pancreatic duct in the uncinate process of the pancreas was dilated. This led us to conclude that decompression of the main pancreatic duct alone was insufficient for treatment of the pancreatic fistula. Therefore, pancreaticoduodenectomy was performed 10 days after the initial surgery. This procedure was found to be useful for treatment of an intractable pancreatic fistula with a stenosed common bile duct and main pancreatic duct.
