Gastrointestinal perforation caused by a pancreaticojejunal anastomotic stent: a postoperative case report following pancreaticoduodenectomy.

Abstract

Background: Placement of a support tube during pancreaticojejunal anastomosis has been shown to reduce the incidence of postoperative pancreatic fistula in patients with a non-dilated pancreatic duct. However, increasing reports of long-term complications, such as the presence of an indwelling support tube in the anastomosis, have raised concerns. Despite this, short-term complications, such as gastrointestinal perforation in the absence of tube displacement, remain relatively rare.

Case description: This report describes a 59-year-old female patient who underwent radical pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (T2N0M0). On the 8th postoperative day, she developed back pain, followed by a sudden increase in body temperature, elevated inflammatory markers, and a significant increase in amylase levels in the drainage fluid. Enhanced abdominal computed tomography revealed that one side of the pancreatic duct support tube had penetrated the abdominal cavity, resulting in posterior peritoneal effusion. Emergency removal of the support tube and repair of the intestinal perforation were performed. The patient had an uneventful recovery after surgery and was discharged on day 20 following the second operation.

Conclusions: In cases of postoperative abdominal or low back pain accompanied by signs of infection, complications related to the support tube should be considered. Further studies are needed to evaluate the necessity of placing a pancreatic duct support tube, as well as the timing for its removal after the completion of the anastomosis.