BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent an...BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas.In a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia.There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and fever.Admission examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct.Magnetic resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was performed.The system comprised a nasogastric tube,gauze,and an antimicrobial incise drape.The negative pressure was 125 mmHg,and no adverse events occurred.The patient was discharged on postoperative day 5 without any symptoms.CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.展开更多
文摘BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas.In a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia.There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and fever.Admission examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct.Magnetic resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was performed.The system comprised a nasogastric tube,gauze,and an antimicrobial incise drape.The negative pressure was 125 mmHg,and no adverse events occurred.The patient was discharged on postoperative day 5 without any symptoms.CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.
