Delayed pancreatic fistula: An unaccustomed complication following pancreaticoduodenectomy- a rare case report

INTRODUCTIONand Importance: Post-operative pancreatic fistula is a morbid complication after pancreaticoduodenectomy. Though most of them present in the immediate post-operative period, few case reports have mentioned it even 7 years after index surgery. Here, we report a delayed presentation of pancreatic fistula 6 months after surgery. CASE PRESENTATIONA 57 year old female underwent Whipple's pancreaticoduodenectomy for pancreatic head adenocarcinoma and was discharged with an uneventful post-operative recovery. She presented after 6 months with complaints of abdominal pain and distension which upon evaluation was found to be a pancreatic enzyme rich mutiloculated collection. It was managed with per-cutaneous drain placement. CLINICAL DISCUSSIONPancreatic fistula remained a major cause of morbidity and mortality even after 100 years of its existence. It can be overt fistula which manifest in the immediate post-operative period or occult fistula which manifests long after primary surgery. Various causes of delayed fistula are anastomotic site stricture, previous chemotherapy, infection. The management options available are percutaneous drainage, endoscopic stenting of anastomotic stricture or redoing the anastomosis. CONCLUSIONPancreatic fistula can have a delayed presentation which can be diagnosed and managed with regular follow up.