A CASE OF SEVERE ACUTE PANCREATITIS WITH ANOMALOUS ARRANGEMENT OF THE PANCREATICO-BILIARY DUCTAL SYSTEM AFTER TOTAL GASTRECTOMY

Abstract

A 68-year-old woman developed severe acute pancreatitis immediately after total gastrectomy with regional lymph node dissection for an advanced gastric cancer. Pancreas bed drainage and T-tube drainage of the common bile duct were performed. Cholangiography via T-tube revealed the presence of anomalous arrangement of the pancreatico-biliary ductal system, which might cause mild acute pancreatitis. In this case, hypersecretion of the pancreas and cutting the drainage veins and the lymph vessles from the pancreas and a stasis of the bile and the pancreatic juice due to a rise of duodenal pressure after gastrectomy aggravated the condition of acute pancreatitis. We should entertain a possible association of severe acute pancreatitis in performing gastrectomy for patients with anomalous arrangement of the pancreatico-biliary ductal system and should add reconstruction of the biliary duct as far as nossible.