Postoperative Acute Pancreatitis and Its Sequelae: An Underreported Complication Post Pancreaticoduodenectomy

Abstract

Background: Post-pancreatectomy acute pancreatitis (PPAP), recently defined by the International Study Group for Pancreatic Surgery (ISGPS), is an under-recognised complication that may contribute to postoperative pancreatic fistula (POPF) and severe postoperative morbidity. This report describes a fatal case of severe PPAP following pancreaticoduodenectomy. Case Presentation: A 57-year-old man with a localised juxta-ampullary neuroendocrine tumour underwent pancreaticoduodenectomy with duct-to-mucosa pancreaticojejunostomy. On postoperative day (POD) 2, he developed multi-organ dysfunction with markedly elevated serum amylase levels. Computed tomography on POD 4 confirmed acute pancreatitis of the pancreatic remnant. Although initial clinical improvement was observed, he subsequently developed a late POPF on POD 9. Repeat imaging on POD 14 demonstrated pancreatic necrosis and pancreaticojejunostomy disruption, which was managed with CT-guided pigtail drainage. Following discharge, the patient was readmitted on POD 24 with haemorrhagic shock. CT angiography revealed a bleeding gastroduodenal artery pseudoaneurysm secondary to local enzymatic erosion. Despite successful endovascular embolisation, the patient died from irreversible haemorrhagic shock. Conclusion: Severe PPAP after pancreaticoduodenectomy can progress to pancreatic necrosis, anastomotic disruption, POPF and fatal vascular complications. Early recognition, vigilant postoperative surveillance and prompt multidisciplinary intervention are essential to improve outcomes in this potentially devastating condition.