Late Cholangitis After Pancreatoduodenectomy due to Ischemic Stricture of the Jejunal Loop: A Long Term Complication due to the Terminal Vascularization of the Jejunal Loop

Pancreatoduodenectomy is a complex surgical procedure with a high morbidity rate. The most common complications are postoperative pancreatic fistula, bile leakage, and delayed gastric emptying. Postoperative cholangitis is a serious long-term complication that is less studied but can have severe clinical impact. The previously reported incidence is ~10%. Postoperative cholangitis may not only occur in combination with an anastomotic or intrahepatic biliary stricture but can also occur without obstruction.
Recurrent nonobstructive cholangitis occurs in about 8.4% of patients. Although obstructive cholangitis is best treated by biliary tract intervention, nonobstructive cases are difficult to manage, especially those with multiple episodes of cholangitis and those that do not respond to medical treatment.
In this research letter, we present an interesting and unique case of late cholangitis that occurred in one of our patients 24 years after pancreatoduodenectomy due to ischemic stricture of the jejunal loop without anastomotic stricture.