ROBOTIC PANCREATICODUODENECTOMY AFTER UNSUSPECTED DOUBLE PERFORATION (BILE DUCT AND PORTAL VEIN) DURING ENDOSCOPIC BILIARY STENT PLACEMENT
Marcel Autran Machado*1, Fabio F. Makdissi2, Jose Celso Ardengh2, Marcel C C. Machado1
1University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil; 2HOSPITAL NOVE DE JULHO, Sao Paulo, Sao Paulo, Brazil
Robotic pancreaticoduodenectomy after ERCP that required emergency laparotomy, for duodenal perforation, is presented. During the operation, an unsuspected double perforation (bile duct and portal vein) was found and successfully treated. When the surgical specimen was only attached by a large branch from portal vein, this branch was encircled and opened with identification of the biliary stent. Portal vein branch was clamped for safe removal of the biliary stent with minimum loss of blood. Operative time was 398 minutes.Recovery was uneventful. Absence of endoprosthesis in the common bile duct may arise suspicion of wrongful insertion towards adjacent organs and must be dealt with caution.
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