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Pancreatic Fistula

Fistulas Pancreatic


Presentation

  • In 22 patients the fistula was into the peritoneal cavity and they presented with pancreatic ascites. In 7 patients the fistula tracked up through the mediastinum into a pleural cavity, and they presented with pancreatic pleural effusions.[doi.org]
  • Four patients presented with ascites, one patient presented with ascites and bilateral pleural effusion and the sixth patient presented with left-sided pleural effusion.[ncbi.nlm.nih.gov]
  • On multivariate analysis, presence of pancreatic leak/fistula at discharge was the only significant predictor of readmission, present in 62.5 per cent of all readmitted patients (P 0.001).[ncbi.nlm.nih.gov]
  • CONCLUSION: The safety and minimal invasiveness of LDG were confirmed in the present Japanese nationwide survey.[ncbi.nlm.nih.gov]
  • A patient with massive pancreatic pleural effusion in whom the use of endoscopic retrograde cholangiopancreatography (ERCP) revealed the site of a pancreatic fistula to the pleural cavity is presented.[ncbi.nlm.nih.gov]
Wound Infection
  • One patient had wound infection and needed hospitalization for 23 days. Except for one patient who required pancreatic enzyme supplements for 8 months, no other patient had pancreatic exocrine insufficiency.[ncbi.nlm.nih.gov]
  • Although wound infection and dehiscence were more common in the ODG group, LDG was more often associated with grade B or higher pancreatic fistulas.[ncbi.nlm.nih.gov]
  • According to the Clavien-Dindo classification, one patient had grade 0, two patients had grade I, and one patient had grade II (wound infections). The median length of hospital stay was 22 days (range 21-28 days).[ncbi.nlm.nih.gov]
  • It might be asymptomatic or, when not adequately drained, it may contribute to the development of further complications as abdominal abscess, bleeding, wound infection, pneumonia, sepsis and postoperative mortality ( 1 ).[tgh.amegroups.com]
  • infection, frequent positioning of laparostomy system, then a multiorgane failure occurred and the patient died after 53 days of hospitalization (diagnosis: pancreatic head carcinoma).[pancreas.imedpub.com]
Failure to Thrive
  • The 30-day readmission rate was 27.3 per cent and was due to infection (89%), failure to thrive (32%), nausea/vomiting (15%), or other (15%).[ncbi.nlm.nih.gov]
Neglect
  • .: Gastric serosal patch in distal pancreatectomy for injury: a neglected technique. Injury 1997; 28: 127-29. 12. Ohwada S, Ogawa T, Tanahashi Y et al.: Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy.[degruyter.com]

Workup

Amylase Increased
  • We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course.[ncbi.nlm.nih.gov]

Treatment

  • In case of conservative treatment failure, operative treatment is indicated, but this has significantly higher percentage of morbidity and mortality.[ncbi.nlm.nih.gov]
  • The standard treatment is intubation of the Wirsung duct and in cases where there are no improvements the next proposed form of treatment is surgery.[ncbi.nlm.nih.gov]
  • Despite recent technological advances in the treatment of hepatobiliary pancreatic disease, intractable external pancreatic fistula is still a major critical complication after pancreaticoduodenectomy, and the treatment strategy is not well defined.[ncbi.nlm.nih.gov]
  • This treatment is continued for 2–3 weeks, and the patient is observed for improvement. If no improvement is seen, the patient may receive endoscopic or surgical treatment.[en.wikipedia.org]
  • From the treatment of this case, we conclude that the symptoms and signs of a subphrenic effusion are often obscure; abdominal computed tomography may be required to look for occult, intra-abdominal infection; and active conservative treatment should[ncbi.nlm.nih.gov]

Prognosis

  • Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas. Br J Surg. 1995; 82 :1236–1239. [ PubMed ] [ Google Scholar ] 25. Dodds WJ, Taylor AJ, Erickson SJ, Lawson TL.[ncbi.nlm.nih.gov]

Etiology

  • Maintaining a high index of suspicion is essential for the etiologic diagnosis of pancreatic pleural fistula in children.[ncbi.nlm.nih.gov]
  • The results indicate a significant relationship between etiology of the fistula and treatment effect.[ncbi.nlm.nih.gov]
  • The principal determinants of closure of an external pancreatic fistula are the anatomy of the fistulous tract (end versus side, main duct versus side branch), the presence of downstream ductal obstruction, ongoing peripancreatic inflammation and etiology[ncbi.nlm.nih.gov]
  • Keith J Roberts, Maria Sheridan, Gareth Morris-Stiff and Andrew M Smith, Pancreaticopleural fistula: etiology, treatment and long-term follow-up, Hepatobiliary & Pancreatic Diseases International, 11, 2, (215), (2012). Richard A.[doi.org]

Epidemiology

  • . * Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY † Center of Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY ‡ Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer[journals.lww.com]
  • EPIDEMIOLOGY POPF commonly occur following either PD or distal pancreatectomy (DP). Fistulae after PD The incidence ranges from 0-24% with an average fistula rate of 12.9% following PD [ 4 ].[pancreas.imedpub.com]
Sex distribution
Age distribution

Pathophysiology

  • "Ascites fluid in severe acute pancreatitis: from pathophysiology to therapy". Acta Gastroenterol Belg. 63 (3): 264–8. PMID 11189983. Iacono C, Procacci C, Frigo F, Andreis IA, Cesaro G, Caia S, Bassi C, Pederzoli P, Serio G, Dagradi A (1989).[en.wikipedia.org]
  • This largely relates to a poor understanding of the pathophysiology of this complication. POP is now emerging as a possible critical factor in the underlying pathophysiology of POPF.[dovepress.com]
  • Many pathophysiological aspects of pancreatic disease are as yet obscure, and a fair number of the etio pathogenetic mechanisms adduced are no more than hypothetical.[books.google.it]
  • PATHOPHYSIOLOGY OF INJURY Injuries to the pancreas most commonly result from penetrating trauma caused by gunshot or stab wounds and occur in approximately 20%-30% of all patients with penetrating traumas.[ncbi.nlm.nih.gov]

Prevention

  • Effective methods to prevent pancreatic fistula are still sought.[ncbi.nlm.nih.gov]
  • Following an increase in the use of the GIA stapler for treating a pancreatic stump, more techniques to prevent postoperative pancreatic juice leakage have been required.[ncbi.nlm.nih.gov]
  • BACKGROUND: This study aimed to determine the effect of fibrin glue and polyglycolic acid (PGA) felt on prevention of pancreatic fistula (PF) after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis.[ncbi.nlm.nih.gov]
  • The aim of this study was to present a technique of external drainage of monolayer pancreaticojejunostomy for prevention of POPF.[ncbi.nlm.nih.gov]
  • BACKGROUND: Given that no studies have reported the use of adipose-derived stem cell sheets for the prevention of pancreatic fistulas, it is unclear whether adipose-derived stem cell sheets are effective at preventing this complication.[ncbi.nlm.nih.gov]

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