AN UNUSUAL COMPLICATION RESULTING FROM SURGICAL-TREATMENT OF PERIAMPULLARY TUMORS

Background and methods. The authors describe the rising of four postop erative pancreatic pseudocysts in a series of 20 patients treated for periampullary tumours by pancreaticoduodenectomy (PDT), with the closu re of pancreatic stump, between 1989-1996, The operation was always pe rformed by the pylorus-preserving technique according to Traverso-Long mire. Results, In four patients (20%) 3, 4, 4, and 8 months after PDT with closure of the pancreatic stump, the authors observed the develop ment of pseudocysts (PPC) in the pancreatic remnant. All these patient s previously had a pancreatic fistula, Three symptomatic patients unde rwent surgical drainage of the pseudocyst in a jejunal loop (2) or in the stomach (1); in the asymptomatic patient, the clinical feature and the size of the cyst allowed for conservative treatment. In 2 cases P PC was the consequence of a pancreatic fistula evolved in acute pancre atitis of the stump. The PPC drained by cystogastrostomy appeared 4 mo nths after the closure of the pancreatic fistula: the pancreatic stump was completely substituted by a cyst presenting a communication with the pancreatic duct, Conclusions. The authors conclude that PPC is a r are complication of the pancreatic resection that results from acute o r chronic pancreatitis; sometimes pathogenesis is due to a cyst result ing from the pancreatic duct occlusion by phlogistic tissue as a conse quence of the surgical suture.