A successful case of EUS-guided pancreatic ductal approach for pancreatic divism after Billroth II reconstruction

Abstract

A 63 year-old man was admitted to our hospital due to repeated recurrence of pancreatitis. He had undergone Billroth II reconstruction because of duodenal ulcer perforation in the past. He had high fever and upper abdominal pain. Blood test showed inflammatory response and pancreatic enzyme elevation. Abdominal CT revealed pancreatic and hepatic cyst with inflammatory changes. We suspected infectious pancreatic pseudocyst, and performed percutaneous hepatic cyst drainage. We performed ERCP and diagnosed pancreatic divisum. However it was difficult to approach the pancreatic duct via the minor papilla. On the 16th day, we performed EUS-guided pancreatography, minor papillotomy by the rendezvous method, and placed 5Fr ENPD tube. On the 22nd day, we performed ERCP to confirm no leakage to the pancreatic cysts and placed 7Fr pancreatic stent. After three months we confirmed no leakage of the pancreatic duct. We consider that EUS-guided pancreatic ductal approach is an effective treatment for the case of pancreatic divism after Intestinal reconstruction.