Anastomotic Strictures after Whipple Procedure: A Report of Two Cases

Whipple procedure is a major surgery performed for periampullary cancers. With improved surgical techniques and intensive care, perioperative mortality has become a rare event, occurring in less than 2% of cases; however, morbidity remains common, occurring in 30-50% of cases. Hereby, authors present a case report of two patients who were operated on for periampullary cancer and have now presented with anastomotic site strictures, hepatolithiasis and pancreatitis. Case 1 was a 58-year-old male who underwent the Whipple procedure with pancreaticojejunostomy 13 years ago for periampullary growth. The patient now presented with pancreatitis, dilated Main Pancreatic Duct (MPD), hepatolithiasis and a peptic ulcer with stricture at all three anastomotic sites. A lateral pancreaticojejunostomy, revision of hepaticojejunostomy with removal of calculi and redo gastrojejunostomy were performed using the same Roux limb. Case 2 was a 58-year-old male who underwent the Whipple procedure with pancreaticogastrostomy four years ago for a serous cystadenoma of the pancreas and presented with pancreatitis, dilated MPD and pleural effusion. The patient was diagnosed with pancreatitis due to anastomotic stricture at the pancreaticogastrostomy site and laparotomy with lateral pancreaticojejunostomy was performed. Both patients were discharged uneventfully. While individual anastomotic strictures and their management have been discussed in the literature following the Whipple procedure, Case 1, which presented with strictures at all three sites simultaneously and Case 2, which presented with pancreatitis, are noteworthy and unique. Surgery is the best approach to managing anastomotic strictures, as it offers a one-time solution.