부산대학교 도서관

External intractable pancreatic fistula remains a serious complication following pancreaticoduodenectomy. We report such a fistula treated successfully by interventional internal drainage. A 54-year-old man undergoing pylorus-preserving pancreaticoduodenectomy for lower bile duct carcinoma experienced pancreatic juice discharge from the pancreatico-gastric anastomosis on postoperative day 7. Fistulography showed the main pancreatic duct but no communication between the main pancreatic duct and stomach. Percutaneous transgastric fistulodrainage was not possible because the pancreatic fistula could not be cannulated adequately. We placed a transjugular intrahepatic portosystemic shunt catheter through the pancreatic fistula into the stomach, putting a drainage tube in the shunt area between the pancreatic fistula and stomach. The course after internal drainage was good and the man was discharged 1 month thereafter.