A 66-year-old man with a history of Billroth II procedures for duodenal ulcer presented to our department with obstructive jaundice due to unresectable pancreatic cancer.
We inserted a fully covered metal stent. However, he returned to the hospital because of the pancreatic fistula 3 weeks later. After removing the stent, endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the main pancreatic duct, lesion of the pseudocysts, and leakage of contrast material from the pancreatic head. Therefore, we inserted a 5-Fr endoscopic nasopancreatic drainage tube to bridge the disruption. On day 23 of hospitalization, we replaced the 5-Fr stent with a 7-Fr stent because of persistent stenosis and disruption. Computed tomography showed improvement and the patient was discharged. In this case, endoscopic transpapillary drainage was useful for treatment of pancreatic fistula for reconstructing the intestinal tract.
