Yang Hanteng, Ren Yanxian, Yu Zeyuan, Zhou Huinian, Zhang Shuze, Luo Changjiang, Jiao Zuoyi
Department of General Surgery, Lanzhou University Second Hospital, No.82 Cuiyingmen, Lanzhou, 730030, Gansu, China.
Cuiying Biomedical Research Center, Lanzhou University Second Hospital, No.82 Cuiyingmen, Lanzhou, 730030, Gansu, China.
BMC Surg. 2020 Jul 28;20(1):170. doi: 10.1186/s12893-020-00828-2.
Pancreatic fistula is a common complication after pancreaticoduodenectomy, which could be caused by: soft pancreatic tissue, pancreatic duct diameter < 3 mm and body mass index ≥25 kg/m. Here we report a case of pancreatic fistula due to obstruction of the jejunal loop due to compression of the jejunal loop by the superior mesenteric vessels.
A 68-year-old man was admitted to our ward due to intermittent epigastric distension and pain. After various examinations and treatments, he was diagnosed with middle bile duct cancer. Pancreaticoduodenectomy was performed, and pancreaticojejunostomy and hepaticojejunostomy were completed by lifting the jejunal loop from behind the superior mesenteric vessels to the upper region of the colon. On postoperative day 9, the patient developed acute diffuse peritonitis, and on postoperative day 10, the patient underwent a second exploratory laparotomy, during which it was confirmed that the pancreatic fistula was caused by obstruction of the jejunal loop due to compression of the jejunal loop by the superior mesenteric vessels, then the patient recovered and was discharged alive after retrograde drainage in the jejunum.
The superior mesenteric vessels after pancreaticoduodenal surgery can compress the jejunal loop and cause obstruction leading to serious complications, and it is recommended that general surgeons should avoid lifting the jejunal loop from the posterior aspect of the superior mesenteric vessels to complete the anastomosis.
胰瘘是胰十二指肠切除术后的常见并发症，其可能由以下因素引起：胰腺组织质地柔软、胰管直径<3mm以及体重指数≥25kg/m²。在此，我们报告一例因肠系膜上血管压迫空肠袢导致空肠袢梗阻而引发胰瘘的病例。
一名68岁男性因间歇性上腹部胀痛入院。经过各项检查及治疗，被诊断为中段胆管癌。实施了胰十二指肠切除术，并通过将空肠袢从肠系膜上血管后方提起至结肠上方区域完成了胰空肠吻合术和肝空肠吻合术。术后第9天，患者出现急性弥漫性腹膜炎，术后第10天，患者接受了第二次剖腹探查术，术中证实胰瘘是由于肠系膜上血管压迫空肠袢导致空肠袢梗阻所致，随后患者在进行空肠逆行引流后康复并存活出院。
胰十二指肠手术后肠系膜上血管可压迫空肠袢并导致梗阻，进而引发严重并发症，建议普通外科医生避免从肠系膜上血管后方提起空肠袢来完成吻合术。
