Inadvertent Ligation of the Main Pancreatic Duct: an Extremely Rare Complication of Choledochal Cyst Excision

Pancreatic ductal injury is rare during choledochal cyst excision. Most cases present in the immediate postoperative period with pancreatic fistula or acute pancreatitis are managed conservatively. But, inadvertent ligation of the main pancreatic duct with subsequent recurrent pancreatitis and upstream dilatation of the pancreatic duct requiring a pancreatic ductal drainage operation has not been reported in the English literature. A 23-year-old female patient presented with recurrent episodes of upper abdominal pain for about 16 months. She had a history of type-1 choledochal cyst excision 18 months back. She was evaluated with abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP). MRCP showed hugely dilated main pancreatic duct with normal hepaticojejunostomy anastomosis. There was no residual cyst. MRCP findings were suggestive of stricture of the main pancreatic duct due to previous surgery. Endoscopic pancreatic ductal decompression failed. The patient was treated successfully with pancreaticogastrostomy. Postoperative recovery was uneventful. The patient was well at 24-month follow-up.