Critical Grade C Postoperative pancreatic fistula (POPF) treated with reoperation and direct drainage of the main pancreatic duct

Abstract

A 76-year-old man developed septic shock six days after undergoing SSPPD-II-A-1 for IPMC. He was diagnosed with diffuse peritonitis due to a POPF and emergent reoperation with peritoneal lavage and drainage was necessary. We drained fluid collection spaces and performed a peri-pancreatojejunostomy with a jejunal limb. Although inflammation improved gradually, significant leakage of pancreatic secretions from the peri-pancreatojejunostomy continued. An enteral nutrition catheter was placed in the jejunal limb by IVR for enteral feeding on postoperative day 27. Direct drainage of the main pancreatic duct via the jejunal limb succeeded on postoperative 37, and the leakage of pancreatic secretions from the peri-pancreatojejunostomy gradually decreased. The patient made steady progress and was discharged on postoperative day 92.

A patient with a critical grade C POPF successfully treated by reoperation and direct drainage of the main pancreatic duct by interventional radiology is presented.