Repair of Main Pancreatic Duct Injury during Surgery for Congenital Biliary Dilatation in a Child: A Case Report.

Abstract

Introduction: In surgery for congenital biliary dilatation, it is essential to minimize residual intrapancreatic bile duct tissue to prevent future complications, such as intrapancreatic stones and carcinogenesis. However, dissection of the intrapancreatic bile duct is technically demanding and may result in injury to the main pancreatic duct. As a result, very few cases have been reported regarding the management of this complication in pediatric patients. We present a pediatric case of intraoperative main pancreatic duct injury and describe its surgical management.

Case presentation: A 3-year-old girl was diagnosed with congenital biliary dilatation. During excision of the intrapancreatic bile duct, a small ductal lumen with clear fluid leakage was identified. Contrast imaging through the ductal lumen revealed the entire main pancreatic duct, confirming the diagnosis of intraoperative pancreatic duct injury. Because the anatomical relationship between the injured site and the distal main pancreatic duct toward the papilla was obscured, repair was undertaken with concern for an accidental division of the pancreaticobiliary junction. A 3-Fr short catheter was inserted into the pancreatic duct as an internal stent to secure pancreatic juice drainage. The injured duct was anastomosed to the remnant intrapancreatic bile duct using 7-0 absorbable sutures, and the repair site was covered with surrounding connective tissue. External drainage was placed adjacent to the repair site. She developed a transient postoperative pancreatic fistula, which resolved with conservative management. No episodes of pancreatitis or pancreatic stone formation were observed during 6 years of follow-up.

Conclusions: Intraoperative recognition of main pancreatic duct injury and establishment of a secure pancreatic drainage route using an internal stent can lead to favorable outcomes. This case provides practical insight into the management of a rare but serious complication during pediatric surgery for congenital biliary dilatation.