Cystojejunostomy

Cystojejunostomy is a surgical drainage procedure in which a connection is made between a pancreatic pseudocyst and the jejunum. The goal is to divert the cyst’s fluid contents into the small intestine, providing durable internal drainage and relief of symptoms.

Indications for cystojejunostomy include symptomatic or enlarged pancreatic pseudocysts that persist after conservative management, fail to resolve with less invasive procedures, are infected, or are best accessed from a segment of jejunum identified during imaging or intraoperative assessment. It is considered when endoscopic or percutaneous drainage is not feasible or has failed, and when the pseudocyst closely approaches a loop of jejunum.

Technique and variations: The procedure can be done via open or laparoscopic surgery. A loop of jejunum is brought toward the cyst, and a window is created between the cyst wall and the jejunal wall. A wide, mucosa-to-mucosa anastomosis is constructed to establish a cystojejunostomy, allowing contents to drain directly into the gut. In some cases a Roux-en-Y jejunal limb or separate intestinal segment is used to reduce reflux and improve drainage. The exact configuration depends on anatomy and surgeon preference, but the aim is a durable, wide fistula between the cyst and the jejunal lumen.

Outcomes and complications: When successful, cystojejunostomy can provide durable symptom relief and cyst resolution. Potential complications include anastomotic leak, infection, bleeding, fistula formation, recurrence of the pseudocyst, or intestinal obstruction. It is one of several drainage options for pancreatic pseudocysts, with cystogastrostomy and cystoduodenostomy as alternatives, and endoscopic or percutaneous methods as less invasive options.