Late failure of Frey procedure due to gastro-jejunal fistula formation

Context: Local resection of the pancreatic head with longitudinal pancreaticojejunostomy (or Frey procedure) generally results in excellent pain relief in chronic pancreatitis. We report a patient with chronic pancreatitis who experienced pain recurrence after an uneventful longitudinal pancreaticojejunostomy. Case report: This is a single case study of a 58-year-old female with chronic pancreatitis undergoing longitudinal pancreaticojejunostomy for pain relief. Fifteen months after the surgery, the patient experienced pain recurrence. Radiologic evaluation followed by surgical exploration revealed a gastroenteric fistula to the Roux-limb, with obliteration of the anastomosis. After repair of the fistula and re-excavation of the pancreatic head, a two-layer longitudinal pancreaticojejunostomy was reconstructed from the same Roux-limb. An omental flap was interposed between the Roux limb and the repaired stomach. At 6-month follow-up, the patient was pain free and asymptomatic. Conclusion: Late failure of the Frey procedure due to a gastroenteric fistula to the Roux-limb of jejunum has not been previously reported. This finding may explain one of the causes of longitudinal pancreaticojejunostomy late failure.