Retrograde Pancreatic Duct Stent Migration into the Biliary Tract Presenting as a Rare Early Complication of Pancreaticoduodenectomy (Whipple Procedure)

Abstract

Unusual or unexpected effect of treatment Background: Pancreaticoduodenectomy (Whipple procedure) is an established surgical procedure for the treatment of carcinoma of the head of the pancreas. Modifications to this procedure include gastropancreaticoduodenectomy, which includes the removal of parts of the pancreas, duodenum, and stomach. Complications of surgery include fistula formation, failure of the anastomosis, and leak of pancreatic enzymes, which can be reduced by stenting the pancreatic duct. This report is of a rare complication of pancreaticoduodenectomy and describes a case of retrograde migration of a pancreatic duct stent into the biliary tract through the orifice of the hepaticojejunostomy. Case Report: A 50-year-old man with a history of gastric cancer, underwent gastropancreaticoduodenectomy. Surgery was complicated by displacement of the pancreatic stent to the biliary system, which resulted in postoperative obstructive jaundice and bile leakage from the hepaticojejunostomy between the hepatic duct and the jejunum. An endoscopy was performed and the stent was successfully retrieved. The patient recovered rapidly, the bile leakage resolved, the patient's jaundice resolved, and was discharged home with no further surgical complications. Conclusions: A case is reported of a rare early complication of pancreaticoduodenectomy in a patient with gastric cancer. Endoscopy successfully retrieved the pancreatic duct stent that had migrated into the biliary tract through the orifice of the hepaticojejunostomy.

External pancreatic ductal stenting in minimally invasive pancreatoduodenectomy: How to do it?

“…Stent-related complications have been reported previously. However, they are infrequent and overrated [ 20 ]. None of the patients in our series had stent-related complications such as stent migration, stent-related pancreatitis, peritonitis, kinking, or obstruction of the stent, although these complications are possible in EPDS [ 21 ].…”

Iron-Dependent Cell Death: A New Treatment Approach against Pancreatic Ductal Adenocarcinoma

“…On the one hand, tumors originating in the Vater ampulla, bile duct, or head of the pancreas are managed with a pancreatoduodenectomy (Whipple procedure). On the other hand, tumors located in the tail or body of the pancreas are surgically removed by a pancreatectomy performed distally and some cases require a total pancreatectomy [2]. Regrettably, despite the options for surgical resection, the 5-year survival rate is 25%.…”