Kimura Koichi, Adachi Eisuke, Toyohara Ayako, Omori Sachie, Ezaki Kaoru, Ihara Ryo, Higashi Takahiro, Ohgaki Kippei, Ito Shuhei, Maehara Shin-Ichiro, Nakamura Toshihiko, Maehara Yoshihiko
Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka 815-8588, Japan.
Department of Internal Medicine, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka 815-8588, Japan.
World J Clin Cases. 2021 Aug 26;9(24):7224-7230. doi: 10.12998/wjcc.v9.i24.7224.
Chronic pancreatitis occasionally requires surgical treatment that can be performed with various techniques. Often, this type of surgery presents with postoperative complications. We report a case of a successful retrograde pancreatojejunostomy for chronic pancreatitis and infected pancreatic cysts.
A 62-year-old male with a 10-year history of chronic pancreatitis presented with epigastric pain for one week and a 20 kg weight loss over one year. Computed tomography showed stones in the pancreas (mainly the head), expansion of the main pancreatic duct, and thinning of the pancreatic parenchyma. Magnetic resonance imaging showed infected pancreatic cysts connected to the stomach with a fistula from the splenic hilum to the caudal portion of the liver's lateral segment. An endoscopic retrograde pancreatography was performed; the guide wires could not pass through the stones in the pancreas and therefore, drainage of the main pancreatic duct was not achieved. Next, a distal pancreatomy and splenectomy were performed; however, the pancreatic juice in the remaining parenchyma was blocked by the stones. Hence, we performed a retrograde pancreatojejunostomy and Roux-en-Y anastomosis. The patient had no postoperative complications and was discharged from the hospital on postoperative day 14.
A distal pancreatomy, retrograde pancreatojejunostomy, and Roux-en-Y anastomosis could be an effective surgical procedure for intractable chronic pancreatitis.
慢性胰腺炎偶尔需要手术治疗，可采用多种技术进行。这类手术术后常出现并发症。我们报告一例慢性胰腺炎合并感染性胰腺囊肿逆行胰空肠吻合术成功的病例。
一名62岁男性，有10年慢性胰腺炎病史，出现上腹部疼痛1周，1年内体重减轻20公斤。计算机断层扫描显示胰腺（主要是头部）有结石，主胰管扩张，胰腺实质变薄。磁共振成像显示感染性胰腺囊肿与胃相连，脾门至肝外侧段尾状部有瘘管。进行了内镜逆行胰胆管造影；导丝无法穿过胰腺内的结石，因此未实现主胰管引流。接下来，进行了胰体尾切除术和脾切除术；然而，剩余实质内的胰液被结石阻塞。因此，我们进行了逆行胰空肠吻合术和Roux-en-Y吻合术。患者术后无并发症，术后第14天出院。
胰体尾切除术、逆行胰空肠吻合术和Roux-en-Y吻合术可能是治疗难治性慢性胰腺炎的有效手术方法。
