Endoscopic Management of a Complex Gastrojejunal and Pancreatic Leak Following Pancreaticoduodenectomy

Pancreaticoduodenectomy remains the mainstay of surgical treatment of malignant periampullary disorders. Postoperative morbidity rates are driven by postoperative pancreatic fistula. Although most can be managed conservatively or with percutaneous techniques, complex fistulas including gastroenteric leakage frequently require operative reexploration. Endoscopic therapies in this setting offer an opportunity to avoid invasive reoperation.

We present the case of a 67-year-old male individual who developed a complex intra-abdominal abscess after pancreaticoduodenectomy with confirmed pancreaticojejunal disruption, gastric staple line dehiscence, and enterocutaneous fistula. Five endoscopic sessions utilizing advanced techniques over a period of 60 days led to complete healing of the patient's external fistula, resolution of complex abdominal abscess, creation of functional communication between the gastric staple line disruption and the afferent jejunum, and return of normal gastrointestinal function. Baseline functional and dietary status was restored without gastrointestinal symptoms or necessity for supplemental tube feedings.