The application of long frame draining of pancreatoejunoanastomosis in patient after gastropancreatoduodeonal resection

Objective. To demonstrate the possibilities of early diagnosis of pancreatoejunonastomosis failure and options for surgical treatment of patients with pancreatic fistula after gastropancreatoduodenal resection using long-term frame drainage of pancreatojejunonastomosis.

Materials and methods. The results of combined treatment of a patient of the Department of General Surgery of S. M. Kirov Military Medical Academy with a intraductal papillary mucinous neoplasms. Pancreatoejunonastomosis failure was diagnosed based on the criteria of the International Research Group for the Study of Pancreatic Fistulas.

Results of the study. Patient B., 61 years old. In January 2019, computer tomography revealed a cystic cavity in the head of the pancreas. An controlled endoscopic ultrasound sonography biopsy was performed. Morphological examination verified the signs of intraductal papillary mucinous neoplasm. On March 11, 2019, the patient underwent gastropancreatoduodenal resection with decompression of pancreatoejunoanastomosis using long-term frame drainage of the main pancreatic duct. On the third day of the postoperative period, x-ray contrast fistulography was used to diagnose the failure of the pancreatoejunonastomosis with the formation of a “B” type fistula. On the 23^d day after gastropancreatoduodenal resection, puncture drainage of the non-drained acute fluid collection was performed under ultrasonographic control. On the 36^th day of the postoperative period the frame and puncture drains were removed.

Conclusion. The use of long-term frame drainage for decompression of the duct system with staged fistulography, early diagnosis of complications of gastropancreatoduodenal resection in the form of the formation of type B pancreatic fistula, provided the effectiveness of conservative and minimally invasive measures for the treatment of postoperative complications (8 figs, bibliography: 7 refs).