Background: Common anastomotic complications after pancreatic surgery are leakage from the pancreaticojejunostomy or hepaticojejunostomy. Leakage from a gastro-enteric or entero-enteric anastomosis after pancreatic surgery is rarely described. Aims: To evaluate the incidence of gastro-enteric and entero-enteric leakage and to describe the presentation, treatment and outcome.Methods: Between 1992 - September 2008 a consecutive series of 1141 patients underwent exploration in the Academic Medical Center for potentially resectable pancreatic head or periampullary tumor. Discharge notes, radiologic investigations and operation notes of relaparotomies were evaluated to identify patients with leakage of gastrojejunostomy (GJ), duodenojejunostomy (DJ) or jejunojejunostomy (JJ). Clinical presentation, radiologic findings, treatment and outcome were analyzed.Results: Eight (0.7%) patients had enteric anastomosis leakage; 6 (DJ 5, GJ 1) of 764 patients following pancreatoduodenectomy (PD), and 2 (GJ 1, JJ 1) of 377 patients following palliative bypass procedure. Median postoperative day of diagnosis of enteric leakage was 9 (range 2-23). Clinical signs included tender abdomen, fever, high drain output suspicious of enteric content (absence of amylase or bilirubin) and enterocutaneous fistula. Median peak white blood cell count before diagnosis was 14.6 x109/L (range 8.4-28.0). Common radiological findings were pneumoperitoneum and free or localized fluid. In three patients following PD gastro-enteric leakage developed in association with postoperative pancreatic fistula. Four patients underwent relaparotomy: 2 pylorus-preserving PDs were converted to ‘classic’ PD, 1 had revision of the anastomosis and 1 had primary closure. Other patients were treated by US/CT-guided percutaneous drainage. One patient in the palliative bypass group refused intervention and died on postoperative day 19. Conclusions: A 0.7% enteric leakage rate was responsible for one death related to the complication. Clinical deterioration with tender abdomen and/or high drain output without amylase or bilirubin should raise suspicion of enteric anastomotis leakage. Type of (surgical) treatment depends on index surgery, time interval to diagnosis, clinical situation and extent of anastomotic defect.