Pancreaticojejunostomy: images of an invagination technique.

Pancreaticoduodenectomy is the treatment of choice for resectable periampullary tumors. Anastomosis between the remnant of the pancreas and the intestine can be fashioned by various methods. An anastomotic leak can result in sepsis and even death. The rate of these complications is reported to be 10-28.5% [1]. Two widely used techniques for fashioning a pancreatic anastomosis are practiced: end to side duct to mucosa anastomosis or telescopic invagination of the pancreas into the lumen of the bowel. Some authors have suggested that the invagination technique reduces the rate of anastomotic leaks and the rate of pancreatic fistula formation [2]. These complications directly correlate with morbidity and mortality after a Whipple procedure [3]. We would like to share with the readers interesting computerized tomography (CT) images of a pancreaticojejunostomy fashioned by a telescopic invagination anastomosis between the remnant of the pancreas and a loop of the small bowel.