Abstract
An 80-year-old woman was undergoing pylorus-preserving pancreaticoduodenectomy (PPPD-IVB-2, Billroth I method) for duodenal cancer when she was age 73. A PTCD tube was inserted for post-operative anastomotic stricture of the choledochojejunostomy. She had suffered mild cholangitis once per year after removal of the PTCD tube. Cholangitis increased in frequency after 6.5 post-operative years. She had repeated readmission for recurrent cholangitis. MRCP showed regurgitation of oral contrast at the choledochojejunostomy, but the intrahepatic bile duct was not dilated. Endoscopic retrograde cholangiography (ERC) showed no anastomotic stricture, but the jejunum at the anal side of the anastomosis of the choledochojejunostomy was kinked by adhesion and contrast media was in stasis at the oral side of the jejunum. We diagnosed that the cause of recurrent cholangitis was mainly food regurgitation, and performed gastrointestinal tract conversion surgery 7 years after the PPPD. She has been free from cholangitis since the surgery. Though post-pancreaticoduodenectomy recurrent cholangitis is relatively rare, surgery should be considered if conservative treatment does not control it.
