Korean J Hepatobiliary Pancreat Surg.  2016 May;20(2):89-92. 10.14701/kjhbps.2016.20.2.89.

Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak

• Kaya B
• Ozcabi Y
• Tasdelen I
• Onur E
• Memisoglu

• KMID: 2243022
• DOI: http://doi.org/10.14701/kjhbps.2016.20.2.89

Abstract

Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.

Keyword

Hepaticojejunostomy; Biliary drainage; Anastomosis; Nasogastric tube

MeSH Terms

Abscess
Aged
Bile*
Cholangitis
Common Bile Duct
Diagnosis
Drainage
Female
Humans
Jaundice, Obstructive
Mortality
Pancreaticoduodenectomy*
Peritonitis
Stents

Figure

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  Fig. 1 Magnetic resonance imaging of the coronal section of the upper abdomen showing distal bile duct obstruction.

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  Fig. 2 Magnetic resonance cholangiopancreatography showing dlatation of the common bile duct and intrahepatic bile duct.

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  Fig. 3 A 12-Fr nasogastric tube used for nasobiliary drainage in hepaticojejunostomy anastomosis. Additional side holes were also added for gastric drainage.

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  Fig. 4 A nasogastric tube is pull off from the gastric stump.

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  Fig. 5 A nasogastric tube is inserted into the common hepatic duct before performing hepaticojejenostomy.

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  Fig. 6 A nasogastric tube is put into the anastomosis. A black arrow indicates hepaticojejunostomy anastomosis and a red arrow indicates the internal catheter inside the Wirsung duct.

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