Jejunal perforation caused by transanastomotic pancreaticojejunostomy internal stent following pancreaticoduodenectomy: a case report

Mortality and morbidity following pancreaticoduodenectomy (PD) have significantly decreased due to multimodal treatment approach and refinement in surgical techniques. Despite lacking proven benefits, surgeons continue using pancreaticojejunostomy (PJ) transanastomotic stent to mitigate post-operative pancreatic fistula (POPF). We share a morbid case of jejunal perforation caused by PJ stent. A 69 years male presented with features of gastric outlet obstruction secondary to carcinoma second part of duodenum. After proper optimization, he underwent pylorus resecting PD with child’s reconstruction and placement of a transanastomotic PJ stent. Initial postoperative course was well. Later he developed signs of biliary peritonitis. Computed tomography of abdomen revealed perforation of jejunal segment between PJ and hepaticojejunostomy. Despite urgent re-exploration and repair of perforation, the patient ultimately succumbed to sepsis, multi-organ failure, and died. The case highlights the need for thoughtful consideration while attempting to place PJ stents, given the associated risks and the ambiguous impact on mitigating POPF.