Jejunal Perforation Due to Internal Pancreatic Stents Following Pancreaticoduodenectomy: A Case Series and Technical Modification.

Pancreaticoduodenectomy (PD) is a complex surgical procedure performed to treat various conditions, including pancreatic head cancer and ampullary tumors. Postoperative pancreatic fistulas (POPFs) remain one of the most challenging complications of PD, with potentially severe consequences such as abscess formation, bleeding, and even mortality. To mitigate the risk of POPFs, internal pancreatic stents are often employed to promote healing by diverting pancreatic secretions. Although internal stents offer advantages, including the avoidance of external drainage, complications such as stent migration, cholangitis, and liver abscesses have been commonly documented. A jejunal perforation caused by internal pancreatic stents, however, is an extremely rare complication. In this report, we describe three cases of jejunal perforations caused by internal pancreatic stents following PD and present a modified technique to reduce the risk of this complication. Three cases of jejunal perforation following PD were observed. In Case 1, a 69-year-old female developed intra-abdominal abscesses, and computed tomography (CT) revealed a perforation caused by a pancreatic stent, necessitating reoperation. In Case 2, an 83-year-old male exhibited a perforation and hematoma on CT 36 hours after surgery, requiring reoperation. In Case 3, a 66-year-old male presented with an inflammatory response five days post-surgery. CT revealed stent-related perforation, leading to reoperation. All patients fully recovered following surgical intervention. These cases underscore the importance of careful pancreatic stent placement during PD to minimize complications. The likely cause of the jejunal perforations was the perpendicular angle of the stent placement, leading to erosion of the jejunal wall. To address this issue, a modified technique was introduced, involving advancing the stent 5 cm into the jejunal lumen to reduce any direct pressure on the jejunal wall. This adjustment has prevented further cases of perforation, highlighting the critical need for surgical vigilance and technical modifications to enhance patient outcomes following PD.