A Case of Late-onset Pancreatic Fistula Related to Pancreas Divisum after Distal Pancreatectomy

Abstract

A case of late-onset pancreatic fistula that was related to pancreas divisum after distal pancreatectomy (DP), which was treated with trans-minor papilla and transgastric stenting, is presented. A 72-year-old woman underwent DP for cancer of the tail of the pancreas. Abdominal computed tomography showed a pancreatic pseudocyst due to a late-onset postoperative pancreatic fistula at the pancreatic stump 6 months after surgery. Endoscopic ultrasound-guided transgastric drainage was performed. The pancreas divisum was then diagnosed by endoscopic retrograde cholangiopancreatography. Considering the pancreatic fistula caused by the pancreas divisum, the patient underwent endoscopic minor papillotomy and pancreatic stenting. Following this procedure, the pancreatic pseudocyst disappeared. When pancreas divisum is diagnosed, endoscopic minor papillotomy should be considered to prevent a late-onset pancreatic fistula.