An Informative Case under Total Pancreatic Duct Drainage Procedure after Pancreatoduodenectomy

Total pancreatic duct drainage has been recognized as a safe and leak-proof procedure after pancreatoduodenectomy and this procedure has improved morbidity and mortality. However, the impact of tube complications remains unknown. We treated a patient with an obstructed tube that impaired pancreatic drainage for 23 days. During this period, although serum amylase lavels were elevated, the patient was asymptomatic. On the 24th postperative day (POD), a moderate amount of clear pancreatic juice was excreted abruptly and subsequent drainage was uneventful. During the late postoperative period, the response of the pancreatic juice to an oral diet was sustained and oral glucose tolerance was also maintained. These findings suggest that the effects of obstruction of the main pancreatic duct for 23 days on the residual pancreas are reversible in humans. Thus, in a case with tube complication, one possible strategy is to allow the matter to take its own course. This case illustrates the importance of careful ligature of the pancreatic tube. It is necessary to recheck the patency with a suitable guide-wire, especially one with a small inner diameter.

total pancreatic duct drainage

pancreatic duct obstruction