Proximal migration of transanastomotic pancreatic stent following pancreaticoduodenectomy and pancreaticojejunostomy

Background: The use of catheters to stent the pancreaticojejunal anastomosi s following pancreaticoduodenectomy is practiced by some surgeons. Their lo ng-term effects in this setting, however, remain unknown. Methods. A 60-yr-old woman underwent a potentially curative pylorus preserv ing pancreaticoduodenectomy for Stage I ampullary carcinoma. Roux-en-Y panc reaticojejunostomy was constructed over a short stent. She presented 4 yr l ater with abdominal pain, steatorrhea, and weight loss. Computed tomography revealed a stent within the proximal pancreatic duct, with gross upstream ductal dilatation and parenchymal features of chronic pancreatitis. Results: Laparotomy revealed no disease recurrence. The stent, removed thro ugh a jejunotomy, was occluded. On-table pancreatogram demonstrated a 3-cm proximal duct stricture. Drainage was achieved with a lateral pancreaticoje junostomy (modified Puestow procedure). Recovery was uneventful, with clini cal recovery of pancreatic exocrine function at 6 mo follow-up. Conclusion: Proximal migration of transanastomotic pancreatic stent with su bsequent development of chronic pancreatitis is a potential complication fo llowing pancreaticoduodenectomy. It can be managed effectively with stent r emoval and a lateral pancreaticojejunostomy.