Fig. 2

Patient 5 illustrates the technique of percutaneous Roux-en-Y jejunostomy to access the pancreatic duct for management of an anastomotic fistula after pancreato-duodenectomy. Contrast cavitygram (a) through the percutaneous drain (arrowhead) shows the pancreatic duct (arrow). CT scan image (b) shows the transhepatic trajectory of the percutaneous catheter (arrowhead) entering the Roux-en-Y afferent jejunal limb (arrow). After 2 months of continuous suction of pancreatic secretions through the percutaneous catheter contrast injection (c) shows that the anastomosis (arrow) is completely healed and the pancreatic duct normally drained into the jejunal limb. The catheter was removed. Follow up CT scan (d) 13 years later shows a normal pancreatojejunostomy (arrow) and all peri-pancreatic inflammation completely resolved