A Case of Traumatic Injury of Pancreas which Requires Longitudinal Pancreaticojejunostomy due to Anastomotic Stenosis after Pancreatic Fistulojejunostomy

We report a case of successful longitudinal pancreaticojejunostomy following failure in the long-term patency of an anastomosis in pancreatic fistulojejunostomy. A 27-year-old woman struck in the chest and torso by a male assailant was found in abdominal computed tomography to have swelling and an annular low-density area in the pancreatic head and was diagnosed as having traumatic pancreatic injury. Despite conservative treatment, a pancreatic pseudocyst formed in the right lower quadrant of the abdominal cavity, so it was punctured percutaneously, becoming a fistula continuing to the main pancreatic duct in the body and tail of the pancreas. Based on the failure of conservative therapy, we conducted pancreatic fistulojejunostomy. The women suffered frequantly from acute pancreatitis in the year following surgery, and MRCP showed anastomotic stenosis and dilation of the main pancreatic duct in the pancreatic body and tail. This is turned required longitudinal pancreaticojejunostomy to prevent acute pancreatitis and to preserve pancreatic endocrine and exocrine function. Although fistulojejunostomy is a minimally invasive choice in treating pancreatic fistula, the pancreatic fistula is a originally cicatrix and easily becomes stenotic or necrotic due to incomplete blood flow from the lack of the original artery.