Yoshitaka Nakamura, Akihiro Yamaguchi, Hiroomi Matsumura, Azumi Suzuki,Hiroki Taniguchi
Context Transanastomotic internal pancreatic duct stent placement during reconstruction following pancreaticoduodenectomy is thought to be one of the strategies for preventing postoperative pancreatic fistula and widely performed. However complications related to internal stent migration have very rarely been reported. Here we report a rare case of internal pancreatic stent retrograde migration into the left biliary tree through afferent limb of a Roux-en-Y reconstruction after pancreaticogastrostomy following pancreaticoduodenectomy. Case report A seventy-four-year-old woman underwent subtotal stomach preserving pancreaticoduodenectomy with right hemicolectomy for intraductal papillary mucinous neoplasm of the pancreas head and adenocarcinoma of the cecum. Pancreaticogastrostomy was undertaken during subtotal stomach preserving pancreaticoduodenectomy with internal pancreatic stent placement. Post operative course was uneventful and she was discharged on the fifteenth postoperative day. She remained almost asymptomatic after discharge except for slight vague abdominal pain. Twenty-seven days after the operation, an internal pancreatic stent was detected at right upper quadrant in routine abdominal X-ray at the time of outpatient visit. An abdominal computed tomography scan revealed that a stent was migrated into the left hepatic duct trough hepaticojejunostomy. Enteroscopic retrieval of the stent was then successfully undertaken. Conclusions In the present case, an internal pancreatic stent unexpectedly migrated into the hepatic duct against the peristaltic direction of the afferent limb. Although complications related to surgically placed internal pancreatic stent migration have rarely been reported so far, surgeons should be aware of the possibility of internal stent migration and any postoperative imaging studies should be considered focusing on the position of the devices placed intraoperatively.
