Severe acute pancreatitis 5 years after pancreaticoduodenectomy: A case report

Highlights • Acute pancreatitis is one of complication of pancreaticoduodenectomy. • Delayed severe acute pancreatitis which needs intensive care is very rare. • Necrosectomy effective treated abdominal abscess, but it is important to avoid injury to surrounding organs. • Clinicians should be aware that severe pancreatitis chould occur even after pancreatectomy.
Introduction Acute pancreatitis is a known complication of pancreaticoduodenectomy (PD). However, no reports in the literature describe a late delayed severe acute pancreatitis. We report a case of acute pancreatitis 5 years after PD in a patient who needed intensive care for his complication. Presentation of case A 64-years-old man presented with upper abdominal pain and reported a history of PD 5 years prior to presentation. Contrast-enhanced computed tomography revealed an edematous pancreatic remnant with inflammation of the surrounding tissue, and he was diagnosed with acute pancreatitis. His condition worsened, and he was transferred to our hospital the following day. He was admitted to the intensive care unit to manage respiratory and circulatory insufficiency. Although his condition improved, an abdominal abscess was identified, and necrosectomy was performed on day 43 of hospitalizaiton. We carefully removed as much necrotic tissue as was possible without injury to the pancreaticojejunal anastomosis and the ascending colon. Inflammation gradually subsided, and he was discharged on day 111 of hospitalization. The last drain was removed in day 133 of admission to our hospital. Pancreatitis and abdominal abscess have not recurred until the time of writing this paper. Discussion Delayed severe acute pancreatitis is rare. Necrosectomy can treat an abdominal abscess; however it is important to avoid injury to other organs. Conclusion Clinicians should be aware that severe acute pancreatitis can occur after PD.