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An investigative technique to distinguish between the gastrojejunostomy and the hepaticojejunostomy as the cause of cholangitis following pancreaticoduodenectomy.

BACKGROUND Pancreaticoduodenectomy is associated with a substantial postoperative morbidity and mortality of which sepsis accounts for one-third of complications.1 A common cause of post-pancreaticoduodenectomy cholangitis is hepaticojejunostomy stricture.2 However, if the gastrojejunostomy is formed too proximally on the Roux loop, for example following a Child reconstruction,3 then gastric contraction can cause reflux into the hepaticojejunostomy resulting in cholangitis. We describe a simple technique to detect reflux of gastric contents into the hepaticojejunostomy as the cause of postpancreaticodueodenectomy cholangitis.