Lesiones ampulares tras cirugía gastroduodenal y biliar

We present two cases of ampullary lesions discovered after gastroduodenal and biliary surgery, respectively. Both appeared during the postoperative period as biliopancreatic fistulas, either uncontrolled or of unknown origin, and progressed insidiously toward septic shock when the suppurative process spread toward the retroperitoneum. Computed axial tomography confirmed the extension of the process in both cases. Fistulography and endoscopic retrograde cholangiopancreatography were the most useful diagnostic tests for defining the anatomy of the fistulas. Both patients underwent successful bilioenteric anastomosis and extensive retroperitoneal and pancreaticoduodenal drainage.