BILIO-JEJUNOSTOMY STENOSIS AFTER CEPHALIC-DUODENOPANCREATECTOMY IN CHRONIC PANCREATITIS - CASE REPORT

We present the case of patient SC aged 44 years who underwent surgery 5 years prior to thepresentation to our clinic for a tumor in the head of the pancreas, the operation than consisted of acephalic duodenopancretectomy which was followed by a number of complications. On admissionthe patient had abdominal pain in the right flank, giant median postoperative eventration and aexternal ”a la Witzel” biliary drainage tube. Abdominal ultrasound revealed the presence of ainterhepaticodiaphragmatic collection that measured 4.6 / 3 cm. A cholangiography was donewhich showed biliary tract opacification of the left lobe with the full stop of the contrast in thedistal left main hepatic duct without intrahepatic biliary dilatation. Surgery was undertaken undertotal anesthesia – the intraoperative diagnosis consisted of: almost complete stenosis of the biliojejunostomy.After the adhesions were cut, the bilio-jejunostomy was redone using the left hepaticduct in a terminal-lateral anastomosis. The collection was drained and the abdominal defect wascorrected. The patient maintained a favorable external biliary drainage of about 200 ml per day soin the 5-th postoperative day the drainage was clamped without any complications. Conclusions: 1. Duodenopancreatectomy should be reserved for average / high volume surgical centers. 2. During the intervention the steps to achieve the biliary-digestive anastomosis should be respectedthoroughly 3. Fast reoperation may increase the chance of survival of the patient.