Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: Case report and review of the literature

Abstract

Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) should have stenting of the biliary system to prevent cholangitis. However, the most serious complication of ERCP is pancreatitis. There are only scattered data on the impact of post-ERCP pancreatitis on the surgical management of periampullary tumours. We report the case of a patient with carcinoma of the ampulla of Vater who underwent preoperative biliary stenting complicated with severe acute pancreatitis and was effectively treated by pylorus preserving pancreaticoduodenectomy (PD) 3 months later. In the postoperative course, grade A pancreatic fistula was observed, with no substantial prolongation of hospital stay. Pathological findings revealed stage II ampullary carcinoma with multiple foci of pancreatic necrosis. Three weeks after the procedure, the patient fully recovered, and started adjuvant chemotherapy. Disease free survival DFS was 27 months and OS 44 months. Pancreaticoduodenectomy can be performed after severe acute necrotizing pancreatitis caused by preoperative biliary stenting, provided adequate timing of surgery is ensured, albeit with the risk of postoperative complications. Even severe post-ERCP pancreatitis should not be regarded as a contraindication for curative PD, especially in patients with periampullary adenocarcinoma, since long-term survival can be achieved.