A case of pancreatic abscess after pancreaticoduodenectomy with obstruction by lost stent tube treated by endoscopic trans-gastric drainage

Abstract

An 85-year-old man underwent a pancreaticoduodenectomy (PD) for moderately differentiated tubular adenocarcinoma and had been followed recurrence-free without adjuvant chemotherapy. Three years and 10 months after the operation, he was referred to us with the chief complaints of epigastric pain. A blood test showed increased inflammatory reaction, and enhanced abdominal computed tomography revealed multilocular effusion in the remnant pancreas. A lost stent placed at the pancreaticojejunostomy was found to remain in the pancreatic duct, and we thus diagnosed a pancreatic abscess caused by its obstruction. The abscess was in close contact with the posterior wall of the stomach, and trans-gastric drainage was performed using endoscopic ultrasonography. The inflammatory findings and symptoms were immediately improved after drainage and the abscess cavity was significantly reduced. The lost stent spontaneously fell off and no recurrence of symptoms has been observed since. To the best of our knowledge, this is the first report of pancreatic abscess after PD with obstruction of a lost stent tube treated by endoscopic trans-gastric drainage.