A 70-year-old woman undergoes Whipple's procedure (pancreaticoduodenectomy) for pancreatic head adenocarcinoma. On postoperative day 4, she develops nausea, vomiting, and a nasogastric tube output of >1.5L/day with an otherwise non-tender abdomen and no fever. Amylase-rich fluid is not noted. What is the most likely complication?
- A Post-pancreatectomy hemorrhage
- B Pancreatic fistula
- C Delayed gastric emptying (DGE) ✓
- D Bile leak
Explanation
Delayed gastric emptying (DGE) is the most common complication after pancreaticoduodenectomy, occurring in up to 25-50% of patients. It is characterized by inability to tolerate oral intake, high nasogastric output (>1.5 L/day), nausea and vomiting persisting beyond postoperative day 3, with an otherwise unremarkable abdomen. The International Study Group for Pancreatic Surgery (ISGPS) classifies DGE into grades A, B, and C based on duration. Management is supportive with nasogastric decompression, prokinetics, and nutritional support; most cases resolve with conservative management.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.