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Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports

World Journal of Clinical Cases 2019年第17期7卷 2526-2535页

作者： Tomohide Hori Kohei Ogawa Hidekazu Yamamoto Hideki Harada Kazuyoshi Matsumura Michihiro Yamamoto Masahiro Yamada Takefumi Yazawa Katsutoshi Kuriyama Masaki Tani Daiki Yasukawa Yasuyuki Kamada Yuki Aisu Ryotaro Tani Ryuhei Aoyama Shinnosuke Nakayama Yudai Sasaki Koki Nishimoto Masazumi Zaima Department of Surgery Shiga General HospitalMoriyama 524-8524Japan Department of Hepatobiliary Pancreatic and Breast Surgery Ehime UniversityToon 791-0295Japan Department of Gastroenterology and Hepatology Shiga General HospitalMoriyama 524- 8524Japan Department of Surgery Shiga University of Medical ScienceOtsu 520-2192Japan Department of Surgery Kyoto University Graduate School of MedicineKyoto 606- 8507Japan

BACKGROUND Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess.This refractory complication can be fatal;therefore,intensive treatment is important.Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis,and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL.We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.CASE SUMMARY The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy,and pancreatic leakage was observed postoperatively.Intractable pancreatic fistula led to intraperitoneal abscess,and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8.The abscess resolved after 7 d of CLL.The second patient underwent distal pancreatectomy.Pancreatic leakage was observed,and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump.CLL was instituted from POD 9,and the abscess resolved after 4 d of CLL.The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma.Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula;however,intraperitoneal abscess was detected on POD 59.We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult.CLL was instituted from POD 63,and the abscess resolved after 1 wk of CLL.CONCLUSION CLL has therapeutic potential for postoperative pancreatic fistula.

关键词： Surgery Pancreas Pancreatic fistula Pancreatic juice Postoperative complications Case report

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