Rare Long-Term Complications Following Pancreaticoduodenectomy: Biliary and Pancreatic Lithiasis

Biliary and pancreatic lithiasis are rare complications in postpancreaticoduodenectomy (PD) patients, the possible risk factors and treatment strategies remain unclear. In this study, medical records of patients who underwent PD procedure from 2003 to 2013 in Qilu hospital, Shandong University in China were reviewed retrospectively. Clinical data were collected and statistically analyzed. We found that bile duct stone or pancreatic duct stone occurred in 1.23% patients (6/489), including 4 males and 2 females, with the mean age being 60.6±10.3 years old. The most common symptoms were shivering and fever (6/6, 100%), abdominal pain (4/6, 66.7%), jaundice (3/6, 50.0%) and vomiting (2/6, 33.3%) The mean internal time of onset of symptoms after Whipple procedure was 47.3±27.8 months (9-98). CT scan was the most effective diagnostic method. Reoperations were performed on these patients; anastomotic stricture was confirmed in 3 patients, and then stones removal, complete resection of stricture and reconstruction were performed. Based on our clinical findings, we concluded that lithiasis is still a rare complication after PD. Anastomotic stricture, infection and reflux might be important reasons. The aims of therapy are stone removal and dilation of the anastomotic stricture through non-surgical or surgical procedures. Effective prevention methods can decrease incidence of lithiasis after PD.