Duodenal obstruction following laparoscopic high anterior resection secondary to a peripancreatic fluid collection

We report a rare case of an 82-year-old female who developed acute duodenal obstruction 11 days following an elective laparoscopic high anterior resection for rectosigmoid cancer. Computed tomography scan of the abdomen and pelvis identified a large peripancreatic fluid collection causing compression at the junction of the third and fourth parts of the duodenum. The patient was successfully treated with endoscopic ultrasound-guided fine-needle aspiration of the collection with complete resolution of her obstructive symptoms. Analysis of the aspirate revealed normal amylase and lipase levels. It is hypothesised that the source is most likely pancreatic in nature despite the normal amylase and lipase levels, which can be seen in chronic pancreatitis, as there appeared to be evidence of previous peripancreatic inflammation intra-operatively within the lesser sac during the mobilisation of the splenic flexure. This case serves as an important reminder of the extra care required when mobilising the splenic flexure, particular in the presence of previous peripancreatic inflammation, and highlights the successful management of the obstruction with a minimally invasive transgastric approach to aspirate the collection.