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Double Gastrojejunocolic Fistula as a Late Complication of Pancreatic Head Resection for a Non-Functioning Pancreatic Tumor

Raffaele Pezzilli, Fabio Ferroni, Bahjat Barakat, Lucia Calculli

Pancreatic head resection represents one of the most demanding procedures in abdominal surgery; however, several complications may develop after this type of surgery such as fistulas (internal and/or external), gastrointestinal tract hemorrhage, and abdominal infections. The relaparotomy rate, as well as low perioperative mortality, may be present. The reported postoperative complication rate may range from 23 to 57%, even when an expert surgeon performs the resection. However, late complications of pancreatic head resection are rare. A case of double gastrojejunocolic fistula, which developed in a patient who had undergone pancreatic head resection some years earlier, is herein reported. The patient was admitted to our hospital for abdominal pain associated with nausea and vomiting. She also complained of diarrhea after food ingestion, even in small quantities, and referred the presence of undigested food in the feces and a weight loss of 10 kg in the previous three months. The patient was treated conservatively. We should be aware that symptoms of fistulas due to pancreatic head resections may be diagnosed several years after surgery.