Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports

Figure 1 Case 1. A and B: We placed three drains near the anastomoses of the pancreaticojejunostomy (yellow arrows), choledochojejunostomy (blue arrows), and gastrojejunostomy (purple arrows). For the pancreaticojejunostomy, we ran two drains intentionally through the ventral and dorsal sides (yellow and blue arrows, respectively); C: Pancreatic leakage began early postoperatively, and peak amylase level in the drainage discharge was 23480 U/L. High amylase levels in the drainage discharge were still seen on postoperative day (POD) 8 continuous local lavage (CLL) was initiated on POD 8, and saline volume was increased on POD 12. We continued CLL for 7 d, and amylase levels in the drainage discharge decreased dramatically during that time; D: Contrast computed tomography on POD 8 revealed intractable pancreatic fistula had led to an intraperitoneal abscess around the pancreaticojejunostomy (yellow arrows). CHA: Common hepatic artery; CLL: Continuous local lavage; POD: Postoperative day.