Recurrent hemorrhaging from stomal ulcers following a side to side longitudinal pancreaticojejunostomy for chronic pancreatitis - Report of a case

Gastrointestinal (GI) hemorrhaging secondary to stomal ulcers following a p ancreaticojejunostomy for chronic pancreatitis is a rare postoperative cond ition that has not hitherto been reported in the literature. A 25-yr-old Ja panese female was referred to Ryukyu University Hospital with GI hemorrhagi ng of unknown origin. She had undergone a modified Puestow procedure (Parti ngton procedure) for chronic pancreatitis with pancreatolithiasis and an as sociated dilatation of the main pancreatic duct at 19 yr of age. A techneti um-99m blood-flow scan demonstrated the pooling of radionuclides in the are a of the jejunal loop. which was highly suggestive of bleeding into the jej unum. Over the nest day, she demonstrated persistent melena. At exploratory laparotomy, the anastomotic jejunal loop was filled with clotted blood. Op erative endoscopy through an incision of the jejunal loop in close proximit y to the anastomosis showed oozing blood from the anastomotic jejunal mucos a. Following a resection of the affected anastomotic segment of the jejunum , a side to side longitudinal pancreaticojejunostomy was again performed on this patient. The resected jejunum showed pathologically pseudopolyp-like edema, congestion, and an ulceration of the stomal mucosa. The patient show ed a good postoperative course and has been doing well for the past 8 yr si nce reoperation.