Afferent limb percutaneous jejunostomy to treat pancreatic leak after pancreaticoduodenectomy: a case report

Although the mortality after a pancreaticoduodenectomy (PD) is low, it increases with post-operative pancreatic leaks. In this case, a 76-year-old male with pancreatic head adenocarcinoma after successful PD developed a 6 cm fluid collection by the pancreaticojejunostomy (PJ). Interventional radiology proceeded with percutaneous drainage. Unfortunately, the drain color changed from purulent to bilious. A contrast study confirmed the drain's position within the bowel lumen of the afferent limb. Although not the original intent, the patient progressed. Few cases describe percutaneous drainage of the blind end of the afferent limb. Here, the patient's chronic bowel dysmotility contributed to increased afferent limb pressures, jeopardizing the PJ. Placement of the intra-luminal drain allowed for source control and decompression that promoted pancreatic leak healing. Hence, percutaneous jejunostomy of the blind jejunal end after PD can serve as a minimally invasive technique for pancreatic leaks secondary to increased pressures within the afferent limb.