| Pancreaticojejunostomy is a surgical procedure where the pancreatic duct, which permits drainage of digestive juices (pancreatic enzymes) from the pancreas, is opened and reconnected to the small intestine (jejunum).
Pancreaticojejunostomy is most often used as a treatment for individuals with an inflamed pancreas (chronic pancreatitis) and its accompanying pain. Chronic pancreatitis often causes the common bile duct and/or the pancreatic duct to become obstructed by mineral deposits (calculi), resulting in ongoing and severe pain. In the US, the most common risk factor for chronic pancreatitis is alcoholism. Other causes may include a hereditary predisposition and obstruction of the pancreatic duct resulting from duct narrowing or pancreatic cancer. On rare occasions, an episode of severe acute pancreatitis makes the pancreatic duct so narrow that chronic pancreatitis results. In many cases, the cause of chronic pancreatitis is not known. |
Source: Medical Disability Advisor
| Pancreaticojejunostomy is performed to improve drainage through the pancreatic duct and help relieve the pain of chronic pancreatitis. Other diseases that may be treated using pancreaticojejunostomy include pancreatic cancer, and obstruction of the pancreatic duct by cysts, traumatic injury, or foreign bodies (e.g., parasitic worms). |
Source: Medical Disability Advisor
| Pancreaticojejunostomy is a major surgical procedure requiring a hospital stay. The procedure is performed under general anesthesia and involves making an incision across and through the upper abdominal wall (upper midline or transverse incision) to completely expose the pancreas and other abdominal organs (laparotomy). The pancreatic duct is exposed and opened lengthwise and the small intestine (jejunum) is cut into two sections. The pancreas with its opened duct is then inserted and stitched into the lower section of the jejunum. The upper section of the jejunum is reattached to its lower section (anastomosis) at a point below the pancreas and the abdomen is then closed. A urinary catheter may be inserted to facilitate bladder elimination.
Postoperative medications (opioid analgesics) and nonsteroidal anti-inflammatory drugs (NSAIDs) are administered at regular intervals to alleviate pain. Individual remains in the hospital an average 16 days until he or she is able to move (ambulate) on his or her own, diet returns to normal, and it is clear there are no other postoperative complications. Abdominal sutures are removed 2-3 weeks after surgery on an outpatient basis. |
Source: Medical Disability Advisor
| When performed in high-volume medical centers, the mortality rate of pancreaticojejunostomy is less than 2% (Forsmark 943), less than 5% elsewhere, and success rates as high as 80% have been reported in the management of pain (Abrams 568). A 6 year follow-up study indicated, however, that only 40% to 50% of individuals continued to report pain relief. Explanation for this decline is unknown, but may reflect pain originating from other sources, such as untreated areas of the pancreas, neural inflammation, or duct obstruction.
Older individuals and those who continued to abuse alcohol had the most significant reduction in long-term survival. Overall, 10-year survival is about 70% and 20-year survival is about 45% (Forsmark 943). |
Source: Medical Disability Advisor
| Individuals who have had pancreaticojejunostomy may benefit from pulmonary toilet techniques to prevent postoperative pulmonary complications. Progressive relaxation and deep breathing exercises may be helpful in reducing postoperative pain and speeding recovery. Physical therapy may help increase circulation and make walking easier. These therapies are especially valuable during the first 48 hours after surgery. Individuals may continue with these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing. |
Source: Medical Disability Advisor
| Some individual cases require follow-up surgery to address complications resulting from the initial operation. Complications of pancreaticojejunostomy may include bleeding (hemorrhage), general organ failure (shock), kidney-liver (hepatorenal) failure, postoperative infection of the incision wound, infection of the abdominal cavity (sepsis), and inability to digest food properly. The risk of a leak of pancreatic fluid following a pancreaticojejunostomy is 10% and a leak of this nature contributes to the likelihood of sepsis or abdominal abscesses (Townsend).
If the pancreas is damaged by chronic pancreatitis, it can lose its capacity to produce insulin, resulting in insulin-dependent diabetes in some individuals. |
Source: Medical Disability Advisor
| Individuals require a period of more sedentary work due to weakness and fatigue following surgery, and some individuals may need sedentary duties until fully recovered. Medium to heavy-duty responsibilities should be avoided. |
Source: Medical Disability Advisor
| Abrams, David B. "Chronic Pancreatitis." Conn's Current Therapy 2004. Eds. Robert E. Rakel and Edward T. Bope. 56th ed. Philadelphia: W.B. Saunders, 2004.Forsmark, C. E. "Chronic Pancreatitis." Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Eds. M. Feldman, L. S. Friedman, and M. H. Sleisenger. 7th ed. Philadelphia: W.B. Saunders, 2002. 943-969. Townsend, C. M., and D. C. Sabiston, eds. "Gastrointestinal Complications." Sabiston Textbook of Surgery. 16th ed. Philadelphia: W.B. Saunders, 2001. 215-219. |
Source: Medical Disability Advisor