Статті в журналах: "Fistola pancreatica"

1

Burgess, N. A., H. E. Moore, J. O. Williams, and M. H. Lewis. "A Review of Pancreatico-Pleural Fistula in Pancreatitis and Its Management." HPB Surgery 5, no. 2 (January 1, 1992): 79–86. http://dx.doi.org/10.1155/1992/90415.

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Pancreatico-pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleural cavity, most commonly from an enlarging pseudocyst. We review the literature on the causes, investigations and treatment of pancreatico-pleural fistulae and compare this with our own experience of the case of a 41 year old man with a left sided pancreatico-pleural fistula associated with pancreatic duct obstruction. The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patient was managed conservatively. However, deterioration in the patients' condition led to an urgent but not emergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreatic duct, with associated pleural fistula for which aggressive surgical intervention was indicated. The patient subsequently completely recovered.

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Grobmyer, Stephen R., Darrell L. Hunt, Christopher E. Forsmark, Peter V. Draganov, Kevin E. Behrns, and Steven N. Hochwald. "Pancreatic Stent Placement is Associated with Resolution of Refractory Grade C Pancreatic Fistula after Left-Sided Pancreatectomy." American Surgeon 75, no. 8 (August 2009): 654–58. http://dx.doi.org/10.1177/000313480907500804.

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Pancreatic fistula have been a source of significant morbidity and mortality after left-sided pancreatectomy. The majority of fistulas are classified as Grade A and resolve quickly with no intervention. Grade C pancreatic fistulas, which require percutaneous or operative drainage, are less common and may be associated with morbidity and mortality. We used postoperative endoscopic pancreatic stent placement as an adjunctive strategy in the management of refractory Grade C pancreatic fistulas. Patients undergoing endoscopic pancreatic stent placement for persistent, refractory peripancreatic fluid collections/pancreatic fistula after left-sided pancreatectomy were identified. Eight patients underwent endoscopic pancreatic stent placement for refractory Grade C pancreatic fistulas. Six patients had percutaneous catheter placement; two patients had trans-gastric drainage. Endoscopic retrograde cholangiopancreatography (ERCP) showed extravasation of contrast from the distal end of the pancreatic duct in seven patients. Pancreatic stents were placed in all patients at a median time of 48 days postoperation and left for a median of 47 days. Before stent removal, ERCP demonstrated pancreatic fistula closure. Median time to complete resolution of the fistula was 41 days after stent placement. Endoscopic pancreatic stents were associated with resolution of Grade C fistulas. After distal pancreatectomy, pancreatic stent placement should be considered in the postoperative period for refractory pancreatic fistulas.

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Aziz, Hassan, Shahzaib Ahmad, Faisal S. Jehan, Wasif M. Saif, and Syed Ahmad. "Management of Refractory Pancreatic Fistula: A Review of Literature." Pancreas – Open Journal 5, no. 2 (December 30, 2022): 23–27. http://dx.doi.org/10.17140/poj-5-117.

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Background Chronic non-healing or refractory pancreatic fistulae are rare complications of pancreatic surgery (pancreaticoduodenectomy, distal pancreatectomy) or pancreatitis. Materials and Methods We conducted a thorough literature search of electronic databases such as PubMed, Google Scholar, BioMed Central, and Cochrane Library using the keywords and medical subject headings (MeSH) terms “chronic pancreatic fistula”, “post-operative fistula”, “fistula management” and “refractory pancreatic fistula”. The purpose of this review is to evaluate the management options for refractory pancreatic fistula (PF). Results Literature reveals that refractory pancreatic fistulae have been managed by techniques like endoscopic ultrasound (EUS)-guided techniques like transmural puncture by clamping, puncture of the fistula tract, transmural placement of pigtail stent, and EUSguided pancreaticogastrostomy. Other techniques are postoperative endoscopic pancreatic stent placement in Grade C pancreatic fistula, intestinal decompression catheter insertion into the jejunum, embedding fistulojejunostomy, and fistulojejunostomy. Conclusion In conclusion, embedding fistulojejunostomy, EUS-guided transmural puncture by clamping, and EUS-guided transmural placement of pigtail stent are effective techniques for the management of refractory pancreatic fistulae. Yet further studies in a larger population are recommended.

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Barannikov, Anton Yu, Vladimir D. Sakhno, Vladimir M. Durleshter, Laura G. Izmailova, Andrei V. Andreev, and Evgenii V. Tokarenko. "Differentiated approach to pancreatic-enteroanastomosis in pancreaticoduodenal resection: a clinical experimental controlled trial." Kuban Scientific Medical Bulletin 28, no. 5 (October 30, 2021): 29–46. http://dx.doi.org/10.25207/1608-6228-2021-28-5-29-46.

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Background. Despite decreasing mortality in pancreaticoduodenal resection, the incidence of postoperative complications in such patients remains high. The choice and formation of “reliable” pancreatic-enteroanastomosis remain relevant.Objectives. The improvement of immediate surgery outcomes in pancreaticoduodenal resection via development of a differentiated algorithm for pancreatic-enteroanastomosis formation.Methods. A prospective non-randomised controlled trial enrolled 90 patients with a pancreaticoduodenal resection surgery. The patients were divided in three cohorts, A (n = 30), B (n = 30) and control C (n = 30). Pancreatic shear wave ultrasound elastography was conducted pre-surgery in main cohorts A and B. Average parenchymal stiffness and intraoperative data decided between the two pancreatico-enteric anastomosis techniques, end-to-side or the original pancreatic-enteroanastomosis. Control cohort C had pancreatico-enteric anastomosis without taking into account the pancreas stiffness and macrocondition.Results. Class A postoperative pancreatic fistula was registered in 2 (6.7%) of 30 patients in cohort B; it was transient, asymptomatic, not requiring additional treatment or a longer postoperative period. No class B and C pancreatic-enteroanastomosis failures or stump pancreonecroses were observed in main cohorts A and B. Clinically significant class B and C postoperative pancreatic fistulae were registered in 5 (16.7%) of 30 patients in control cohort C (inter-cohort comparison statistically significant).Conclusion. The proposed differentiated approach to pancreatic-enteroanastomosis formation associates with a reliably low postoperative complication frequency and lack of clinically significant class B and C postoperative pancreatic fistulae.

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Valikhnovska, K. G. "Retrospective analysis of risk factors for occurrence of pancreatic fistula in patients following pancreaticoduodenectomy." Reports of Vinnytsia National Medical University 22, no. 3 (September 28, 2018): 436–41. http://dx.doi.org/10.31393/reports-vnmedical-2018-22(3)-07.

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Pancreaticoduodenectomy still is a “gold standard” in treatment of hepatopancreaticobiliary tumors. The causes of pancreatic fistula were analyzed in 414 patients aged from 22 to 81 following pancreaticoduodenectomy due to periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve outcomes of pancreatic resection based on a retrospective analysis of the causes of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. Influence of risk factors of pancreatic fistula formation was evaluated by Pirson’s method (χ2). The factors contributing to the occurrence of pancreatic fistulas included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head; χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=17.83,1, p=0.0001, p<0.001) and technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage; χ2=16.40,1, p=0.0001, p<0.001). The detailed study of risk factors for the occurrence of pancreatic fistula is essential for improving the prognosis, prophylaxis and treatment of this pathology. The quality of the surgical intervention and the course of the postoperative period in patients with periampullary tumors depend on the choice of resection type, techniques for surgical interventions on the pancreas.

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Aswani, Yashant, Shehbaz MS Ansari, Ulhaas S. Chakraborty, Priya Hira, and Sudeshna Ghosh. "Where there is pancreatic juice, there is a way: Spontaneous fistulization of severe acute pancreatitis-associated collection into urinary bladder." Indian Journal of Radiology and Imaging 30, no. 04 (October 2020): 529–32. http://dx.doi.org/10.4103/ijri.ijri_349_20.

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AbstractPancreatic fluid collections (PFC) are notorious for their extension beyond the normal confines of the pancreatic bed. This distribution is explained by dissection along the fascial planes in retroperitoneum due to the digestive enzymes within the PFC. In genitourinary track, PFCs have been described to involve the kidneys and the ureters. We report a case of severe acute necrotizing pancreatitis in a 28-year-old male, chronic alcoholic, who on readmission developed features of cystitis. The urine was turbid but did not show significant bacteriuria. Close location of the PFC near the urinary bladder (UB) prompted evaluation of urinary lipase and amylase. Elevated urinary enzyme levels suggested a Pancreatico-vesical fistula, conclusive demonstration of which was established by CT cystography. Percutaneous drainage of the necrosum and stenting of pancreatic duct led to spontaneous healing of the pancreatico-vesical fistula. Our case reiterates the remarkable property of pancreatic enzymes to dissect the fascial planes which is demonstrated by decompression of PFC via UB causing spontaneous Pancreatico-vesical fistula. Further, presence of main pancreatic duct fistulization should prompt endoscopic-guided stenting to obliterate the communication with the fistula and accelerate healing.

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7

Ignjatovic, Dragan, Goran Kronja, Sidor Misovic, and Dragan Mirkovic. "External transluminal drainage of the pancreatic duct due to fistula caused by postbioptic pancreatic necrosis." Vojnosanitetski pregled 62, no. 5 (2005): 413–16. http://dx.doi.org/10.2298/vsp0505413i.

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Background. Pancreatic fistulas are not frequent after the needle biopsy of the pancreatic head. The aim was to present a patient with this type of fistula who was managed using the surgical method never previously applied in our surgical practice. Case report. In our patient, pancreatic fistula appeared at the site of the needle biopsies due to the development of the necrosis. Since the conservative treatment with octreotide and the total parenteral nutrition were without result, we turned to the surgical treatment by placing a silicone prosthesis along the pancreatic duct into the duodenum, next through the Roux-en-Y flexure to provide the external drainage of a pancreatic juice. Postoperatively, applying the conservative treatment, pancreatic fistula disappeared, and a silicone prosthesis was removed three weeks later. Conclusion. The described surgical procedure can be successful in managing fistulas which occur after the pancreatic necrosis.

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8

Tudor, A., C. Molnar, C. Nicolescu, C. Rosca, Bianca Tudor, V. O. Tudor, and C. Copotoiu. "Cephalic Duodeno-Pancreatectomy with Pancreatic-Gastric Anastomosis with Double Purse String, in Patient with Lithiasis and Tumoral Jaundice - Case Report." Acta Medica Marisiensis 60, no. 5 (October 1, 2014): 227–30. http://dx.doi.org/10.2478/amma-2014-0047.

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Abstract Introduction: One of the most feared complications after cephalic duodeno-pancreatectomy remains pancreatic fistula. In recent years, various methods of pancreatico-digestive reconstruction were performed in order to reduce the rate of pancreatic fistula. One of these methods is pancreatico-gastric reconstruction by using two purse string threads. Case report: We present in this article a patient with jaundice with mixed etiology: tumoral and lithiasic. Subjectively, the patient accused sclerose-skin-jaundice, right upper quadrant and epigastric pain, nausea and vomiting. Computed tomography revealed dilatation of intraand extrahepatic bile ducts, a dilated Wirsung duct and a tumor at the biliopancreatic confluence, leading to a suspicion of vaterian ampulom. Upper endoscopy revealed a tumor protruding in the descending duodenal segment. Intraoperatively a tumor suggestive of vaterian ampulom and duct stones was shown. Surgical treatment consisted of coledocolitotomy, cephalic duodeno-pancreatectomy with pancreatic-gastric anastomosis, performed by using two purse string threads. The postoperative evolution was favorable. Conclusion: Pancreatico-gastric anastomosis using two purse string threads is a simple, safe and quick procedure, avoiding the application of sutures through the pancreatic parenchyma and thus reducing the rate of pancreatic fistula.

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Sguinzi, R., F. Pugin, C. Bader, A. Meyer, L. Buhler, L. Widmer, D. Staudenmann, and B. Egger. "Massive Haematochezia due to Splenic Artery Bleeding into the Colon: Unusual Manifestation of Advanced Pancreatic Cancer." Case Reports in Surgery 2023 (January 12, 2023): 1–5. http://dx.doi.org/10.1155/2023/7443508.

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We describe a case of an uncommon early pancreatic cancer presentation in a patient in his 60s who had haemorrhagic shock from extensive haematochezia and required blood transfusions as well as surveillance in an intensive care unit. A splenic artery pseudoaneurysm that had been effectively embolized by angiography was seen to be actively bleeding into the colon lumen on a computerized tomography (CT) scan along with a necrotic mass of the pancreatic tail. A pancreatic mucinous adenocarcinoma was diagnosed by a transgastric biopsy. A pancreatico-colic fistula was discovered by CT scan after a colic contrast enema. A transabdominal drainage of the necrotic collection and targeted antibiotic treatment had been performed with a satisfying patient outcome. In order to assess a potential secondary surgical resection, systemic chemotherapy was planned. In conclusion, haematochezia with hemodynamic instability originated from a splenic artery pseudoaneurysm fistulising into the colon (arterio-colic fistula) and sepsis originating from a tumoral pancreatic abscess fistulising into the colon (tumoral pancreatico-colic fistula).

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Tudor, A., C. Molnar, C. Copotoiu, VO Butiurca, C. Nicolescu, Tudor Bianca, and Gurzu Simona. "Pancreatico-Gastric Anastomosis with and without Sutures – Experimental Swine Model." Acta Medica Marisiensis 61, no. 2 (June 1, 2015): 105–9. http://dx.doi.org/10.1515/amma-2015-0032.

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Abstract Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches. Methods. Our experimental model is based on ten piglets, which were divided into 2 groups. In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas. Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group. Conclusions. In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

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Mihai, Catalina, Mariana Floria, Radu Vulpoi, Loredana Nichita, Cristina Cijevschi Prelipcean, Vasile Drug, and Viorel Scripcariu. "Pancreatico-Pleural Fistula – from Diagnosis to Management. A Case Report." Journal of Gastrointestinal and Liver Diseases 27, no. 4 (December 31, 2018): 465–69. http://dx.doi.org/10.15403/jgld.2014.1121.274.ple.

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Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fistula is rare. Here we report a case of massive pleural effusion secondary to a fistula in the left hemi-diaphragm, between a pancreatic pseudocyst and the left pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. This fistula developed after several episodes of un-investigated acute pancreatitis. The pleural effusion was treated by three thoracocenteses, without recurrence.

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Tudor, A., VO Butiurca, C. Nicolescu, Bianca Tudor, Simona Gurzu, C. Molnar, and C. Copotoiu. "Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives." Acta Medica Marisiensis 61, no. 3 (September 1, 2015): 172–75. http://dx.doi.org/10.1515/amma-2015-0058.

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Abstract Introduction. Although in recent years there have been various versions of pancreatic - digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated. Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method. Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico - digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ductomucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients). Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes. Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

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Sommer, Camille Anne, and C. Mel Wilcox. "Pancreatico-pericardial fistula as a complication of chronic pancreatitis." F1000Research 3 (January 29, 2014): 31. http://dx.doi.org/10.12688/f1000research.3-31.v1.

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Pancreatico-pericardial fistula is an extremely rare complication of chronic pancreatitis. We present a case of a 58-year-old man who presented with syncope. Transthoracic echocardiogram revealed a pericardial effusion with tamponade physiology. Pericardiocentesis and pericardial fluid analysis demonstrated a lipase level of 2321 U/L. Subsequently, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, confirming the presence of a pancreatico-pericardial fistula (PPF) from the distal body of the pancreas. A pancreatic duct stent was placed across the duct disruption on two separate occasions; however, despite stent placement, the patient continued to re-accumulate pericardial fluid and deteriorated. While rare, PPFs may complicate chronic pancreatitis, may not respond to pancreatic duct stenting and may portend a poor prognosis.

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Kusnierz, Katarzyna, Slawomir Mrowiec, and Pawel Lampe. "A Comparison of Two Invagination Techniques for Pancreatojejunostomy after Pancreatoduodenectomy." Gastroenterology Research and Practice 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/894292.

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Background.The aim of the study was to compare two invagination techniques for pancreatojejunostomy after pancreatoduodenectomy.Methods.For effective prevention of the development of pancreatic leakage, we modified invagination technique that we term the “serous touch.” We analysed the diameter of the main pancreatic duct, the texture of the remnant pancreas, the method of the reconstruction, pancreatic external drainage, anastomotic procedure time, histopathological examination, and postoperative complications.Results.Fifty-two patients underwent pancreatoduodenectomy with pancreatojejunostomy using “serous touch” technique (ST group) and 52 classic pancreatojejunostomy (C group). In the ST group one patient (1.9%) was diagnosed as grade B pancreatic fistula, and no patient experienced fistula grade A or C. In the C group 6 patients (11.5%) were diagnosed as fistula grade A, 1 (1.9%) patient as fistula grade B, and 1 (1.9%) patient as fistula grade C. There was a significant statistical difference in incidents of pancreatic fistula (P<0.05) and no statistical difference in other postoperative complications or mortality in comparison group. Anastomosis time was statistically shorter in the ST group.Conclusions.“Serous touch” technique appeared to be easy, safe, associated with fewer incidences of pancreatic fistulas, and less time consuming in comparison with classical pancreatojejunostomy.

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Munirathinam, Manoj, Pugazhendhi Thangavelu, and Ratnakar Kini. "Pancreatico‑pleural Fistula: Case Series." Journal of Digestive Endoscopy 09, no. 01 (January 2018): 026–31. http://dx.doi.org/10.4103/jde.jde_23_17.

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ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

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Ishizaki, Yoichi, Jiro Yoshimoto, Hiroyuki Sugo, Hiroshi Imamura, and Seiji Kawasaki. "Validation of Mucosal Sutureless Pancreatojejunostomy after Pancreatoduodenectomy." American Surgeon 80, no. 2 (February 2014): 149–54. http://dx.doi.org/10.1177/000313481408000222.

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Although duct-to-mucosa pancreatojejunostomy has been considered safer than other techniques, this procedure is particularly difficult when the pancreatic duct is small. It has therefore become increasingly necessary to develop a simple mucosal sutureless pancreatojejunostomy technique to replace the conventional hand-sewing one. Two hundred fourteen patients who underwent mucosal sutureless pancreatojejunostomy were classified into two groups: those with a normal pancreatic duct diameter (less than 3 mm, n = 97) and those with a dilated pancreatic duct (3 mm or greater, n = 117). The rate of clinically significant pancreatic fistula (Grade B or C by the International Study Group on Pancreatic Fistula definition) among the patients as a whole was 8 per cent. The overall incidence of pancreatic fistula was significantly higher in the patients with a pancreatic duct diameter of less than 3 mm than in those with a pancreatic duct diameter of 3 mm or greater. However, the incidence of clinically significant pancreatic fistula did not differ between the groups (less than 3 mm, 11%; 3 mm or greater, 5%; P = 0.09). Grade C pancreatic fistula developed in one patient with a pancreatic duct diameter of less than 3 mm and in two with a pancreatic duct diameter 3 mm or greater. Although two patients required reoperation, all of the fistulas were cured and the postoperative mortality rate related to pancreatoduodenectomy was zero. Mucosal sutureless pancreatojejunostomy combined with pancreatic duct stenting is associated with a low rate of clinically significant pancreatic fistula even in patients with a small pancreatic duct diameter less than 3 mm.

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Pedrazzoli, Sergio, Cosimo Sperti, and Claudio Pasquali. "An Easier Technique for End to End Pancreatlcojejunostomy." HPB Surgery 9, no. 3 (January 1, 1996): 141–43. http://dx.doi.org/10.1155/1996/18087.

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Breakdown of the pancreaticoenterostomy is responsible for a number of complications and for the high mortality associated with pancreaticoduodenectomy. Although in recent years the postoperative mortality has dropped to less than 10% and in some to less than 5%, pancreatic fistula remains the most common and troublesome complication.Various procedures, such as duct ligation or occlusion, resection of the pancreatic stump or pancreaticogastrostomy, have been proposed to treat the pancreatic stump when it is considered unsuitable for jejunal anastomosis. A little trick permitted us to perform 41 consecutive end to end pancreaticojejunostomies, irrespective of the conditions of the pancreatic stump, with only 3 pancreatic fistulas (7%) and without fistula related deaths.

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Desu, Bharath Kumar, Supreeth Kumar Reddy Kunnuru, Mayank Kumar Gurjar, Varun Palanati, Muni Krishna Salavakam, Rakesh R., Gurudutt P. Varty, Praneeth Reddy Challapalli, and Thirunavukkarasu S. "A study on predictive factors for anastomotic leakage in enteropancreatic anastomosis in a tertiary centre in Andhra Pradesh." International Surgery Journal 6, no. 9 (August 28, 2019): 3297. http://dx.doi.org/10.18203/2349-2902.isj20194069.

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Background: This study aimed to identify various factors influencing occurrence of post-operative pancreatic fistula.Methods: Only those patients who underwent standard pancreatojejunostomy anastomosis in duct to mucosa technique using vicryl 4-0 sutures (double layer- interrupted fashion) were included in the study. Patients who had duct size ≤3 mm underwent papillary like main pancreatic duct invaginated technique of pancreaticojejunostomy (fish mouth type).Results: In 40 patients, 10 patients (25%) developed postoperative pancreatic fistula. 5 (12.5%) patients had grade A pancreatic fistula and 5 patients had CR–POPF [grade B–3(7.5%), grade C–2(5%)]. Pancreatic fistula in relation with duct size has attained statistical significance. When all the four factors were put together and given fistula risk score, it correlated well with the occurrence of fistula. Fistula risk score has high negative predictive value. Of 40 patients, 13 patients fall into low risk zone, out of which 1 patient developed grade A fistula. 26 patients fall into moderate risk zone, out of which 4 patients developed grade A, 3 patients developed grade B and 1 patient developed grade C fistula. One patient fall into high risk zone and developed grade C fistula.Conclusions: We found in our study that, post-operative pancreatic fistulae could be modestly predicted using fistula risk score. However, the latter had high negative predictive value and thus could be used to prognosticate risk of non-development of fistula than predicting its severity.

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Valikhnovska, K. G. "Pancreatic fistulae following pancreatic resection. Analysis of causes and prevention methods." Reports of Vinnytsia National Medical University 22, no. 4 (December 28, 2018): 640–46. http://dx.doi.org/10.31393/reports-vnmedical-2018-22(4)-11.

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The causes of pancreatic fistula were analyzed in 503 patients aged from 22 to 81who underwent pancreaticoduodenectomy for pancreatic and periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve the outcomes of pancreatic resection based on a retrospective analysis of the risk factors of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. The influence of factors on the risk of pancreatic fistula was investigated by Pearson method (χ2). The factors contributing to the occurrence of pancreatic fistulae included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head, χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=12.75,1, p<0.001), technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage, χ2=44.01,1, p<0.0001), resection of venous vessels following distal pancreatic resection (χ2=8.350,1, p=0.0039, p<0.01), glycemic level in the preoperative period (P=0.0344,U=15061), the presence of concomitant diseases in patients (χ2=15.62,1, p=0.0001, p<0.001). Preoperative glycemic level and the presence of concomitant diseases in patients are factors that can be influenced to prevent the onset of pancreatic fistula in the postoperative period in patients who are scheduled for pancreatic resection. Prevention of this complication involves the correction of glycemic level and treatment of concomitant pathology in patients in the preoperative period.

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Garale, Mahadeo Namdeo, Yogesh Prabhakar Takalkar, and Karthik Venkatramani. "Clinical study of enterocutaneous fistula." International Surgery Journal 4, no. 9 (August 24, 2017): 2972. http://dx.doi.org/10.18203/2349-2902.isj20173705.

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Background: An enterocutaneous fistulae (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death.Methods: This descriptive study was conducted prospectively in the Department of Surgery between September 2004 and August 2010. Patients whom develop ECF after surgery were included in the study while patients with esophageal, biliary, pancreatic, and perianal fistulas were excluded. The description of fistula included cause, anatomical location, fistula output, complications, and outcome. Fistula output was quantified by direct measurement, in the presence of drain or by calculating number of dressing pads soaked per day. To examine the statistical significance of association between attributes, Chi-square test and Fisher's exact test were used. A probability value of less than 5% (P < 0.05) was considered significant.Results: A total of 42 patients were included in the study, of which 23 were males and 19 were females and the male:female ratio was 1.2:1. Most patients with ECF were aged 41-50 (mean age, 44.23±2.72). Of the 42 patients, 9 patients had colonic fistula and the remaining had small intestinal fistula; 16 ileal, 5 duodenal, and 12 jejunal. There were 22 patients with high-output fistula as compared to 20 patients with low output fistula. Mortality was significantly higher in patients with males, age >60 years, high-output fistula, mesenteric ischemia as underlying pathology, serum albumin <2.5g/dl and re-surgery.Conclusions: Early diagnosis and stabilization form key aspects of management of ECF as most patients are managed conservatively. Prompt nutritional supplementation alters the outcome of this disease. High output fistulae required mostly surgical management and had high morbidity and mortality.

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Violi, Vincenzo, Carlo Salvemini, Antonio Darecchio, Paolo Detullio, and Renato Costi. "Pure Pancreaticocutaneous Fistula Shunted Into the Urinary Bladder. Lesson Learned by an Incomplete, Original Attempt." International Surgery 99, no. 3 (May 1, 2014): 258–63. http://dx.doi.org/10.9738/intsurg-d-13-00110.1.

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Abstract Because pancreaticocystostomy is a method of exocrine secretion management in pancreas transplantation, a legitimate question is whether a pure pancreatic fistula could be shunted into the bladder. After duodenopancreatectomy for cancer, a pancreaticojejunostomy leakage was treated by pancreas-saving anastomosis disconnection. The resulting pure pancreaticocutaneous fistula was later diverted into the bladder using a Denver valved-pump device. Technical problems necessitated redoing the shunt using a modified technique and device. Although the system did work, catheter displacement outside the bladder finally caused device takedown and external fistula restoration. Our attempt did not succeed mostly because of our inexperience in dealing with an altogether novel issue without appropriate technology. Supposing its feasibility, a pancreatic-bladder shunt might have a role in treating pure pancreatic fistulas or creating an external fistula whenever the pancreatic remnant is unreliable for an anastomosis, or when a leaked anastomosis' disconnection is preferable to completion pancreatectomy.

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Maeda, Koki, Naohisa Kuriyama, Yuki Nakagawa, Takahiro Ito, Aoi Hayasaki, Kazuyuki Gyoten, Takehiro Fujii, et al. "Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection." PLOS ONE 16, no. 11 (November 9, 2021): e0259701. http://dx.doi.org/10.1371/journal.pone.0259701.

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Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

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Warshaw, Andrew L. "Jejunum or Stomach for the Pancreatic Anastomosis After Pancreaticoduodenectomy." HPB Surgery 10, no. 3 (January 1, 1997): 191–93. http://dx.doi.org/10.1155/1997/76467.

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Objective: The authors hypothesized that pancreaticogastrostomy is safer than pancreaticojejunostomy after pancreaticoduodenectomy and less likely to be associated with a postoperative pancreatic fistula.Summary Background Data: Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy, occurring in 10% to 20% of patients. Nonrandomized reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with postoperative complications.Methods: Between May 1993 and January 1995, the findings for 145 patients were analyzed in this prospective trial at The Johns Hopkins Hospital. After giving their appropriate preoperative informed consent, patients were randomly assigned to pancreaticogastrostomy or pancreaticojejunostomy after completion of the pancreaticoduodenal resection. All pancreatic anastomoses were performed in two layers without pancreatic duct stents and with closed suction drainage. Pancreatic fistula was defined as drainage of greater than 50 mL of amylase-rich fluid on or after postoperative day 10.Results: The pancreaticogastrostomy (n=73) and pancreaticojejunostomy (n=72) groups were comparable with regard to multiple parameters, including demographics, medical history, preoperative laboratory values, and intraoperative factors, such as operative time, blood transfusions, pancreatic texture, length of pancreatic remnant mobilized, and pancreatic duct diameter. The overall incidence of pancreatic fistula after pancreaticoduodenectomy was 11.7% (171145). The incidence of pancreatic fistula was similar for the pancreaticogastrostomy (12.3%) and pancreaticojejunostomy (11.1%) groups. Pancreatisc fistula was associated with a significant prolongation of postoperative hospital stay (36±5 vs. 15±1 days) (p<0.001). Factors significantly increasing the risk of pancreatic fistula by univariate logistic regression analysis included ampullary or duodenal disease, soft pancreatic texture, longer operative time, greater intraoperative red blood cell transfusions, and lower surgical volume (p<0.05). A multivariate logistic regression analysis revealed the factors most highly associated with pancreatic fistula to be lower surgical volume and ampullary or duodenal disease in the resected specimen.Conclusions: Pancreatic fistula is a common complication after pancreaticoduodenectomy, with an incidence most strongly associated with surgical volume and underlying disease. These data do not support the hypothesis that pancreaticogastrostomy is safer than pancreaticojejunostomy or is associated with a lower incidence of pancreatic fistula.

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Nestler, Sebastian, Andreas Neisius, Frederik Roos, Christian Hampel, Peter Rubenwolf, Wolfgang Jäger, Joachim W. Thüroff, and Christian Thomas. "Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience." Urologia Internationalis 95, no. 3 (2015): 346–51. http://dx.doi.org/10.1159/000381561.

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Introduction: To evaluate incidence, symptoms and management of postoperative pancreatic fistula (POPF) after urologic surgery based on our experience. Material and Methods: Database was searched for clinically evident POPF after urologic surgery between 1998 and 2014. Fistulae were graded using the POPF classification. Clinical course of every POPF patient was evaluated. Results: During this time, 3,200 surgeries for renal, adrenal and retroperitoneal pathologies were performed. Twelve POPF occurred postoperatively in this series. Eight fistulae were POPF grade A, 3 POPF grade B and one POPF grade C. POPF became clinically evident after a median of 3 days (IQR 2-3). In all POPF grade A/B patients, secretion from the pancreatic fistula completely subsided under conservative therapy. In one POPF grade C patient with positive surgical margins of urothelial cancer, conservative treatment failed and the patient died due to POPF-related sepsis. Conclusions: POPF is a rare complication after urologic surgery. Conservative therapy is the first choice of treatment and will be successful in the majority of cases. Pancreatic fistula after surgery of recurrent malignancy may have a poor outcome.

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Chabowski, Mariusz, Wiktor Pawlowski, Michał Lesniak, Agnieszka Ziomek, Maciej Malinowski, Tadeusz Dorobisz, and Dariusz Janczak. "Successful postoperative pancreatic fistula treatment with the use of somatostatin infusion after duodenal gastrointestinal stromal tumor resection." Srpski arhiv za celokupno lekarstvo 147, no. 7-8 (2019): 484–87. http://dx.doi.org/10.2298/sarh180413053c.

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Introduction. According to the International Study Group on Pancreatic Fistula, a postoperative pancreatic fistula is defined as every case of fluid leak on the third (or later) postoperative day, in which the level of amylase in the collected fluid is at least three times higher than the serum amylase level. Depending on the stage and the designated management, pancreatic fistulas are divided into the following three categories: A (mild), B, and C (severe). Regardless of favorable conditions, exocrine pancreatic secretion is the key factor in fistula formation. The decrease in pancreatic secretion caused by somatostatin and its analogues combined with parenteral nutrition is a well-established treatment method in pancreatic fistula management. Case outline. The case of a 69-year-old patient who had undergone a resection of a duodenal gastrointestinal stromal tumor located directly above the major duodenal papilla is presented. Excessive drainage of amylase-rich fluid was observed in the postoperative period. Treatment comprised continuous infusion of somatostatin and parenteral nutrition. Fistula closure was accomplished on postoperative day 14, confirmed by a radical decrease in the volume of drainage and low amylase levels in the collected fluid. The patient remained in a good clinical state and was discharged from hospital on postoperative day 20. Conclusion. This is an example of the early diagnosis of a postoperative pancreatic fistula, treated conservatively with the use of somatostatin. Post-surgery clinical awareness of the importance of direct contact between the stromal tumor and pancreatic tissues, in connection with routine amylase level assessment, led to a quick diagnosis of pancreatic fistula and the therapy led to an uneventful outcome.

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Klein, Fritz, Igor Maximilian Sauer, Johann Pratschke, and Marcus Bahra. "Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy." HPB Surgery 2017 (January 17, 2017): 1–7. http://dx.doi.org/10.1155/2017/9747421.

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Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.

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Sajika Dighe, Raju Shinde, Sangita Shinde, and Mohit Gupte. "A rare case of pancreaticopleural fistula patient presented in surgery OPD." International Journal of Research in Pharmaceutical Sciences 11, SPL4 (December 21, 2020): 1329–32. http://dx.doi.org/10.26452/ijrps.v11ispl4.4301.

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Pancreatico-pleural fistula is rare and infrequent complication of commonly occurring chronic pancreatitis leading to an extra-peritoneal abnormal connection between the pancreatic system and pleural cavity. Diagnosis needs high-level clinical suspicion to avoid delay in the diagnosis as the patient presents with respiratory distress rather than any abdominal symptom and produces large quantities of pleural fluid intractable of pleural tapping or chest drain. Diagnosis of the fistula is clicked by elevated pleural fluid amylase. Various imaging options are available with their unique importance like CECT, ERCP and MRCP. In a low resource, setup CECT becomes a useful modality to delineate the pancreatic parenchymal changes, pancreatic duct anatomy and fluid collection, thus aid in the diagnosis. Treatment modalities depending on structural anatomy of the duct and parenchymal destruction are either Medical, Conservative and Surgical. Here our patient presented with massive left sided pleural effusion resistant to surgical intervention secondary to chronic pancreatitis in a 28-year man later diagnosed as Pancreatico-pleural fistula on CECT. The patient underwent distal pancreatectomy with splenectomy with decortication of the lung with excision of PPF. The patient now is continuous follow-up for chronic pancreatitis and is symptom-free from last 2 years.

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Sheehan, Maureen K., Kimberly Beck, Steve Creech, Jack Pickleman, and Gerard V. Aranha. "Distal Pancreatectomy: Does the Method of Closure Influence Fistula Formation?" American Surgeon 68, no. 3 (March 2002): 264–68. http://dx.doi.org/10.1177/000313480206800309.

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The appropriate closure of the pancreatic remnant after distal pancreatectomy is still debated. Suture techniques, stapled closure, and pancreaticoenteric anastomosis all have their supporters. In this study we have reviewed our data from distal pancreatectomy to determine whether the type of remnant closure or underlying pathologic process had any relation to postoperative fistula formation. We performed a retrospective chart review of patients undergoing distal pancreatectomy at our institution between 1993 and 2001. The charts were reviewed for morbidity and mortality. These were then related to the type of closure of the pancreatic stump. From 1993 to 2001 a total of 86 patients underwent distal pancreatectomy. Data were available on 85 patients. Indications for surgery were pancreatic tumor (69%), pancreatitis (14%), trauma (7%), and extra pancreatic disease (9%). Pancreatic fistula occurred in 14 per cent (N = 12), intra-abdominal abscess in 8 per cent (N = 7), and wound infection in 2 per cent (N = 2). There was no mortality in the series. The incidence of pancreatic fistula formation was not related to method of closure of the pancreatic remnant nor to the underlying pathologic process. Postoperative pancreatic fistulas will close spontaneously even without total parenteral nutrition.

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Коpchak, V. М., L. О. Pererva, О. V. Duvalko, V. V. Khanenko, S. V. Аndronik, S. V. Suhachov, and V. О. Кropyvnytskyi. "The methods of prophylaxis of the morbidity occurrence after pancreatico-duodenal resection." Klinicheskaia khirurgiia 86, no. 5 (May 5, 2019): 3–7. http://dx.doi.org/10.26779/2522-1396.2019.05.03.

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Objective. To elaborate the system of measures with objective of lowering of the occurrence rate for pancreatic fistula and severe complications after pancreaticoduodenal resection (PDR). Маterials and methods. Results of treatment was analyzed for 143 patients, to whom pancreaticoduodenal resection performed. In accordance to the scheme proposed, using elaborated scale of the risk for occurrence of postoperative pancreatic fistula, were operated 56 patients in 2017 - 2018 yrs (the main group). Comparative group consisted of 87 patients, operated in the clinic in 2015 - 2016 yrs without estimation of the risk for postoperative pancreatic fistula occurrence and sarcopenia presence, and formation of pancreaticojejunoanastomosis have depended upon decision of a surgeon-operator. Results. The rate of occurrence of the postoperative complications was trustworthily higher in the comparison group (c2 = 5.8, p=0.01). In the main group a clinically significant pancreatic fistula of Grade В was observed in 1 of 7 patients with postoperative complications. In the comparison group pancreatic fistulas of Grades В or С were diagnosed in 15 of 26 patients with postoperative complications, which are trustworthily higher, than in the main group (c2 = 4.16, p=0.04). Conclusion. The system of measures elaborated gave the possibility to reduce the occurrence rate for pancreatic fistula significantly - from 17.2 tо 1.8% and severe postoperative morbidity - from 29.9 tо 12.5%.

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Malya, Fatma Umit, Mustafa Hasbahceci, Yunus Tasci, Huseyin Kadioglu, Mehmet Guzel, Oguzhan Karatepe, and Kemal Dolay. "The Role of C-Reactive Protein in the Early Prediction of Serious Pancreatic Fistula Development after Pancreaticoduodenectomy." Gastroenterology Research and Practice 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/9157806.

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Introduction. Despite recent advances in surgical techniques, pancreatic fistulas are common. We aimed to determine the role of C-reactive protein in the prediction of clinically relevant fistula development. Materials and Methods. Data from patients who underwent pancreaticoduodenectomy between 2012 and 2015 is collected. Postoperative 1st, 3rd, and 5th day (POD1, POD3, and POD5) C-reactive protein (CRP) levels, postoperative pancreatic fistula (POPF) development, other complications, length of hospital stay, and mortality were recorded. Results. Of 117 patients, 43 patients (36.8%) developed complications (including fistulas). Of the patients developing fistulas, 21 (17.9%) had POPF A, 2 (1.7%) had POPF B, and 7 (6.0%) had POPF C. POD5 CRP and POD3 CRP were shown to be significantly correlated with mortality and development of clinically relevant POPF (p=0.001 and p=0.0001, resp.) and with mortality (p=0.017), respectively. The development of clinically relevant POPFs (B and C) could be predicted with 90% sensitivity and 82.2% specificity by POD5 CRP cut-off level of 19 mg/dL and with 100% sensitivity and 63.6% specificity by the difference between POD5 and POD1 CRP cut-off level of >2.5 mg/dL. Conclusion. CRP levels can effectively predict the development of clinically relevant pancreatic fistulas.

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Aimoto, Takayuki, and Eiji Uchida. "Postoperative Pancreatic Fistula after Pancreaticoduodenectomy: Toward "Zero Pancreatic Fistulas"." Nihon Ika Daigaku Igakkai Zasshi 5, no. 4 (2009): 193–201. http://dx.doi.org/10.1272/manms.5.193.

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Matsumoto, Ippei, Keiko Kamei, Shumpei Satoi, Takuya Nakai, and Yoshifumi Takeyama. "Pancreaticogastrostomy Prevents Postoperative Pancreatic Fistula of Portal Annular Pancreas During Pancreaticoduodenectomy." International Surgery 101, no. 11-12 (December 1, 2016): 550–53. http://dx.doi.org/10.9738/intsurg-d-16-00044.1.

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Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.

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Jiang, H., N. Liu, M. Zhang, L. Lu, R. Dou, and L. Qu. "A Randomized Trial on the Efficacy of Prophylactic Active Drainage in Prevention of Complications after Pancreaticoduodenectomy." Scandinavian Journal of Surgery 105, no. 4 (August 20, 2016): 215–22. http://dx.doi.org/10.1177/1457496916665543.

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Background and Aims: This randomized controlled trial was conducted to examine whether prophylactic active drainage decreases morbidity associated with pancreati-coduodenectomy. Material and Methods: A prospective, randomized controlled trial was conducted between April 2010 and May 2015 when 160 consecutive patients following elective pancreaticoduodenectomy were randomized intraoperatively to either prophylactic active drainage group or conventional passive drainage group. The main objectives were the incidence of postoperative pancreatic fistula and the associated clinical outcomes. Results: There were 82 patients in the active drain group and 78 patients in the passive drain group. The overall pancreatic fistula rate occurred similarly in the two groups (11.0% (9/82) vs 14.1% (11/78), p = 0.360). Grade C pancreatic fistula in active drain group was significantly less than that in passive drain group (0% (0/82) vs 6.4% (5/78), p = 0.026). The mean postoperative hospital stay and parenteral nutrition support time in active drainage group were shorter than those in passive drainage group (12.6 days vs 14.5 days, p = 0.037; 6.9 days vs 8.6 days, p = 0.047, respectively). Conclusion: Prophylactic active drainage reveals significant reduction in severity of complications associated with pancreatic fistula and might be recommended as an alternative for patients with high risk of developing serious pancreatic fistula after pancreaticoduodenectomy.

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Ali, Jaber A. Al, Henry Chung, Peter L. Munk, and Michael F. Byrne. "Pancreatic Pseudocyst with Fistula to the Common Bile Duct Resolved by Combined Biliary and Pancreatic Stenting – A Case Report and Literature Review." Canadian Journal of Gastroenterology 23, no. 8 (2009): 557–59. http://dx.doi.org/10.1155/2009/597208.

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Pancreatic pseudocysts develop in 10% to 20% of patients with chronic pancreatitis, and can cause a variety of complications such as infection, bleeding or development of fistulae. However, fistulous communication with the common bile duct is very rare. The present report describes an unusual case of a patient with a large, symptomatic pancreatic pseudocyst with a fistula to the common bile duct that was treated successfully by combined biliary and pancreatic stenting.

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Bartsch, D. K., P. Langer, V. Kanngießer, V. Fendrich, and K. Dietzel. "A Simple and Safe Anastomosis for Pancreatogastrostomy Using One Binding Purse-String and Two Transfixing Mattress Sutures." International Journal of Surgical Oncology 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/718637.

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Pancreatic anastomotic leakage remains a persistent problem after pancreaticoduodenectomy (PD), especially in the presence of a soft, nonfibrotic pancreas. A modified technique for pancreatogastrostomy was devised, which combines one binding purse-string and two transfixing mattress sutures between the pancreatic stump and the posterior gastric wall. This technique was applied in 35 patients after PD for malignant and benign diseases of whom 10 (28.6%) had a soft pancreas. Median time for the anastomosis was 18 minutes. Operative mortality was zero, and morbidity was 34.3%. Three (8.6%) patients developed a pancreatic fistula (2 type A, 1 type B) as classified according to the International Study Group on pancreatic fistula. All fistulas resolved without further intervention. The described technique is a simple and safe reconstruction procedure after PD that warrants further evaluation.

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Dusch, N., A. Lietzmann, F. Barthels, M. Niedergethmann, F. Rückert, and T. J. Wilhelm. "International Study Group of Pancreatic Surgery Definitions for Postpancreatectomy Complications: Applicability at a High-Volume Center." Scandinavian Journal of Surgery 106, no. 3 (April 4, 2017): 216–23. http://dx.doi.org/10.1177/1457496916680944.

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Introduction: The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity. Methods: Between 2004 and 2014, 769 patients underwent resection. Data were collected in a prospective database. Univariate examination was performed using the χ2-test. Continuous data were tested with the Mann–Whitney U-test. Student’s t-tests and Fisher’s exact tests were performed. Results: A total of 542 patients were included in this study. In all, 91 (16.8%) patients developed postoperative pancreatic fistula, 69 of them clinically relevant grades B and C postoperative pancreatic fistula. Grades B and C postoperative pancreatic fistulas were significantly associated with a longer hospital stay. The postoperative pancreatic fistula grade significantly correlated with re-operation. Totally, 32 (5.9%) patients developed postpancreatectomy hemorrhage. Postpancreatectomy hemorrhage grade was significantly associated with re-operation and 30-day mortality. In all, 14 of 19 patients with grade C postpancreatectomy hemorrhage (73.7%) were re-operated; 3 had a simultaneous postoperative pancreatic fistula C. Grade B postpancreatectomy hemorrhage significantly prolonged hospital stay. Grade C postpancreatectomy hemorrhage significantly prolonged intensive care unit stay. Grade C postpancreatectomy hemorrhage led to longer intensive care unit stay but a shorter hospital stay. Delayed gastric emptying occurred in 131 (24.2%) patients. The delayed gastric emptying grade was significantly associated with re-operation. Nine of the re-operated patients had a simultaneous postoperative pancreatic fistula C. Grades A, B, and C delayed gastric emptying were associated with prolonged hospital- and intensive care unit stay. Conclusion: Delayed gastric emptying is the most common specific complication after pancreas resection, followed by postoperative pancreatic fistula and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery definitions are well applicable in clinical routine and the different grades correlate well with severity of clinical condition, length of hospital or intensive care unit stay, and mortality. Their widespread use can contribute to a more reproducible and reliable comparison of surgical outcomes in pancreas surgery.

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Adams, David B., and Ajai Srinivasan. "Failure of Percutaneous Catheter Drainage of Pancreatic Pseudocyst." American Surgeon 66, no. 3 (March 2000): 256–61. http://dx.doi.org/10.1177/000313480006600306.

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Percutaneous catheter drainage (PCD) of symptomatic pancreatic pseudocysts under CT radiologic guidance is a valuable adjunct or alternative to operative pseudocyst management. PCD failure is characterized by the development of recurrent pseudocysts or external pancreatic fistulas. The purpose of this study is to define the cause and management of PCD failure patients. A retrospective review and analysis of patients with symptomatic pancreatic pseudocysts managed with PCD who required subsequent operative treatment because of PCD failure was undertaken. There were 23 study patients (18 men, 5 women) with a mean age of 44 years identified over a 13-year time period. Pancreatitis etiology was alcohol abuse in 10, gallstones in 7, pancreas divisum in 3, trauma in 2, and sphincter of Oddi dysfunction in 1. Endoscopic retrograde cholangiopancreatography findings were: 13 genu strictures, 4 main pancreatic duct dilations, 2 head strictures, 1 body stricture, 1 stricture in the tail, 1 intact duct, and 1 unknown. Operations used to manage PCD failures were: lateral pancreaticojejunostomy (LPJ) in 9 patients, Roux-en-Y pancreatic fistula jejunostomy in 7, distal pancreatectomy in 3, caudal pancreatectomy in 2, pancreatoduodenectomy in 1, cyst gastrotomy in 1, and caudal pancreatojejunostomy in 1. Follow-up has ranged from 1 to 13 years (mean, 5 years). Five patients who underwent pancreatic fistula jejunostomy developed recurrent pseudocysts or pancreatitis. There have been no recurrent pseudocysts or fistulas in patients managed with LPJ or pancreatic resection. Genu strictures were the cause of PCD failure in the majority of patients. LPJ is the treatment of choice for genu strictures but may not always be possible because of chronic inflammatory changes. Roux-en-Y pancreatic fistula jejunostomy is an acceptable alternative. Recurrent pseudocysts in the head and body are treated with LPJ with cyst incorporation. Pancreatic resection is appropriate for certain strictures of the head, body, and pancreatic tail. Failure of PCD is associated with an underlying ductal disorder that needs to be defined preoperatively with endoscopic retrograde cholangiopancreatography to select the appropriate operation.

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Abdalla, Sala, Ioannis Nikolopoulos, and Rajab Kerwat. "Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis." Case Reports in Emergency Medicine 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/4269424.

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Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.

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Vuorela, Tiina, H. Mustonen, A. Kokkola, C. Haglund, and H. Seppanen. "Impact of pasireotide on postoperative pancreatic fistulas following distal resections." Langenbeck's Archives of Surgery 406, no. 3 (January 20, 2021): 735–42. http://dx.doi.org/10.1007/s00423-021-02083-2.

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Abstract Purpose Postoperative pancreatic fistula (POPF), a difficult complication after surgery, can cause peripancreatic fluid collection and infections in the operative area. In addition, pancreatic fluid is corrosive and can lead to postoperative bleeding. Clinically significant grade B and C fistulas (CR-POPF) increase postoperative morbidity, resulting in a prolonged hospital stay. Delaying adjuvant therapy due to fistula formation in cancer patients can affect their prognosis. In this study, we aimed to determine if pasireotide affects fistula formation, and the severity of other complications in patients following pancreatic distal resections. Data and methods Between 2000 and 2016, 258 distal pancreatectomies were performed at Helsinki University Hospital and were included in our analysis. Pasireotide was administered to patients undergoing distal resections between July 2014 and December 2016. Patients received 900-μg pasireotide administered twice daily perioperatively. Other patients who received octreotide treatment were analyzed separately. Complications such as fistulas (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), reoperations, and mortality were recorded and analyzed 90 days postoperatively. Results Overall, 47 (18%) patients received pasireotide and 31 (12%) octreotide, while 180 patients (70%) who received neither constituted the control group. There were 40 (16%) clinically relevant grade B and C POPFs: seven (15%) in the pasireotide group, three (10%) in the octreotide group, and 30 (17%) in the control group (p = 0.739). Severe complications categorized as Clavien–Dindo grade III or IV were recorded in 64 (25%) patients: 17 (27%) in the pasireotide group, 4 (6%) in the octreotide group, and 43 (67%) in the control group (p = 0.059). We found no 90-day mortality. Conclusions In this study, pasireotide did not reduce clinically relevant POPFs or severe complications following pancreatic distal resection.

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Leandros, Emanuel, Pantelis T. Antonakis, Konstantinos Albanopoulos, Chris Dervenis, and Manousos M. Konstadoulakis. "Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas." Canadian Journal of Gastroenterology 18, no. 5 (2004): 303–6. http://dx.doi.org/10.1155/2004/901570.

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BACKGROUND AND PURPOSE:Gastrointestinal and pancreatic fistulas are characterized as serious complications following abdominal surgery, with a reported incidence of up to 27% and 46%, respectively. Fistula formation results in prolonged hospitalization, increased morbidity/mortality and increased treatment costs. Conservative and surgical approaches are both employed in the management of these fistulas. The purpose of the present study was to assess, evaluate and compare the potential clinical benefit and cost effectiveness of pharmacotherapy (somatostatin versus its analogue octreotide) versus conventional therapy.PATIENTS AND METHODS:Fifty-one patients with gastrointestinal or pancreatic fistulas were randomized to three treatment groups: 19 patients received 6000 IU/day of somatostatin intravenously, 17 received 100 µg of octreotide three times daily subcutaneously and 15 patients received only standard medical treatment.RESULTS:The fistula closure rate was 84% in the somatostatin group, 65% in the octreotide group and 27% in the control group. These differences were of statistical significance (P=0.007). Overall mortality rate was less than 5% and statistically significant differences in mortality among the three groups could not be established. Overall, treatment with somatostatin and octreotide was more cost effective than conventional therapy (control group), and somatostatin was more cost effective than octreotide. The average hospital stay was 21.6 days, 27.0 and 31.5 days for the somatostatin, octreotide and control groups, respectively.CONCLUSIONS:Data suggest that pharmacotherapy reduces the costs involved in fistula management (by reducing hospitalization) and also offers increased spontaneous closure rate. Further prospective studies focusing on the above parameters are needed to demonstrate the clinicoeconomic benefits.

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Maciver, A., M. McCall, D. Mihalicz, D. Al-Adra, R. Pawlick, and A. M. J. Shapiro. "The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model." HPB Surgery 2011 (October 25, 2011): 1–6. http://dx.doi.org/10.1155/2011/624060.

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We investigate the effectiveness of buttressing the surgical stapler to reduce postoperative pancreatic fistulae in a porcine model. As a pilot study, pigs (n=6) underwent laparoscopic distal pancreatectomy using a standard stapler. Daily drain output and lipase were measured postoperative day 5 and 14. In a second study, pancreatic transection was performed to occlude the proximal and distal duct at the pancreatic neck using a standard stapler (n=6), or stapler with bovine pericardial strip buttress (n=6). Results. In pilot study, 3/6 animals had drain lipase greater than 3x serum on day 14. In the second series, drain volumes were not significantly different between buttressed and control groups on day 5 (55.3 ± 31.6 and 29.3 ± 14.2 cc, resp.), nor on day 14 (9.5 ± 4.2 cc and 2.5 ± 0.8 cc, resp., P=0.13). Drain lipase was not statistically significant on day 5 (3,166 ± 1,433 and 6,063 ± 1,872 U/L, resp., P=0.25) or day 14 (924 ± 541 and 360 ± 250 U/L). By definition, 3/6 developed pancreatic fistula; only one (control) demonstrating a contained collection arising from the staple line. Conclusion. Buttressed stapler failed to protect against pancreatic fistula in this rigorous surgical model.

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Kriger, Andrey, David Gorin, Ayrat Kaldarov, Stanislav Berelavichus, Gleb Galkin, Valeriya Pletneva, and Grigoriy Karmazanovsky. "A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES." International Journal of Medical Reviews and Case Reports 2, Reports in Surgery and Dermatolo (2018): 1. http://dx.doi.org/10.5455/ijmrcr.pancreatic-fistula.

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Pawar, Vinay Balasaheb, Pravin Rathi, Ravi Thanage, Prasanta Debnath, Sujit Nair, and Qais Contractor. "Early Endoscopic Intervention in Pancreaticopleural Fistula: A Single-Center Experience." Journal of Digestive Endoscopy 11, no. 04 (December 2020): 263–69. http://dx.doi.org/10.1055/s-0040-1721655.

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Abstract Background Pancreaticopleural fistulas are among the rarest complications of chronic pancreatitis. The main objective of the research, conducted on a total of seven patients, was to evaluate the effectiveness of early endoscopic management of pancreaticopleural fistula. Methods The diagnosis of fistula was reached when fistulous tract was demonstrated on imaging studies and/or pleural fluid amylase level was greater than 2,000 U/L. The data were retrospectively analyzed from the records. Results The prototype patient in our series was a chronic alcoholic male with median age of 45 years. Computed tomography scan was performed in all the seven patients but could diagnose leak only in four patients. Magnetic resonance cholangiopancreatography was better in the remaining three patients for diagnosing fistula. Endoscopic retrograde cholangiopancreatography was the most sensitive test that diagnosed fistula in all the seven patients. Pancreatic duct (PD) cannulation was successful and pancreatic sphincterotomy with PD stenting was performed in all the seven patients. We could avoid surgical intervention in our patients. Conclusions We advise early endoscopic treatment within 7 days of symptom onset as opposed to 3 weeks, which was proposed previously. Medical therapies should be complimentary to PD stenting.

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Guzman, Eduardo A., Rebecca A. Nelson, Joseph Kim, Alessio Pigazzi, Vijay Trisal, Benjamin Paz, and Joshua Di Ellenhorn. "Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections." American Surgeon 75, no. 10 (October 2009): 954–57. http://dx.doi.org/10.1177/000313480907501020.

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Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

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Drozdov, E. S., E. B. Topolnitskiy, S. S. Klokov, and T. V. Dibina. "Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study." Kuban Scientific Medical Bulletin 28, no. 2 (April 15, 2021): 33–45. http://dx.doi.org/10.25207/1608-6228-2021-28-2-33-45.

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Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, p < 0.01).Conclusion. A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.

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Shen, Yi, Binbin Guo, Laiyong Wang, Hui Peng, Jinfang Pan, Qi Zhang, Long Huang, Fuhai Zhou, and Qingsheng Yu. "Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration." American Surgeon 86, no. 4 (April 2020): 334–40. http://dx.doi.org/10.1177/000313482008600429.

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Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function ( P = 0.041), pancreatic texture ( P = 0.029), degree of splenomegaly ( P = 0.003), and operative method ( P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.

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TAGHLAOUI, Rachid. "The pancreatico-pleural fistula - About one case." Journal of functional ventilation and pulmonology 10, no. 31 (June 15, 2019): 41–44. http://dx.doi.org/10.12699/jfvpulm.10.31.2019.41.

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Mech, Katarzyna, Łukasz Wysocki, Tomasz Guzel, Marcin Makiewicz, Paweł Nyckowski, and Maciej Słodkowski. "A review of methods for preventing pancreatic fistula after distal pancreatectomy." Polish Journal of Surgery 90, no. 2 (April 30, 2018): 38–44. http://dx.doi.org/10.5604/01.3001.0011.7491.

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Pancreatic fistula is one of the most severe complications after pancreatic surgeries. The risk of pancreatic fistula after distal pancreatectomy is up to 60%. Effective methods to prevent pancreatic fistula are still sought. A unified definition of pancreatic fistula, which was introduced in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), has allowed for an easier diagnosis and determination of fistula severity, as well as for a reliable inter-center comparison of data. Furthermore, a number of publications point out the risk factors of pancreatic fistula, which may be classified into patient-related risk factors, such as MBI, gender, smoking tobacco or pancreatic structure; and surgery-related risk factors, such as blood loss, prolonged surgery and non-underpinning of the major pancreatic duct. The analysis of risk factors and the use of different methods for the prevention of pancreatic fistula, including novel surgical techniques, may reduce both, the formation and severity of fistula. This will, in turn, lead to reduced secondary complications and mortality, as well as a shorter hospital stay. We present a literature review on different strategies used to prevent pancreatic fistula. It seems, however, that multicenter, prospective, randomized studies in two large groups of patients after pancreatectomy are necessary to establish clear recommendations for the preventive management.

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Sedarous, M., I. Balubaid, A. Basden, and A. Rahman. "A242 THE AIR BETWEEN US: A CASE OF PSEUDOCYST PERFORATION POST-ENDOSCOPIC CLIPPING OF A BLEEDING PANCREATIC-COLONIC FISTULA." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 299–300. http://dx.doi.org/10.1093/jcag/gwab002.240.

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Abstract Background Pancreatic fistula is an uncommon complication of pancreatitis and is associated with increased morbidity. We discuss a case of pancreatic-colonic fistulization followed by the first reported case of pseudocyst perforation post-colonoscopy. Aims Case Methods A 51 year-old female with decompensated alcoholic cirrhosis admitted with hepatic encephalopathy developed large volume hematochezia during admission. Past medical history includes pancreatic pseudocyst, GERD and remote hernia repairs. For the hematochezia, she was investigated with an EGD and colonoscopy. In the distal descending colon, a bleeding lesion was identified and treated with clips and epinephrine injection (Figures 1 and 2). Five hours post-procedure, she developed abdominal distention. CT abdomen pelvis revealed large volume of free air and simple fluid within the abdominal cavity likely secondary to rupture pseudocyst rupture. The previously visualized pseudocyst was filled with gas plastered against the descending colon. She remained medically stable with conservative management. Results Discussion Conclusions Pancreatic-colonic fistula is an uncommon but potentially life-threatening complication of acute pancreatitis associated with high risk of complications. They are found in 4% of admitted inpatients with acute pancreatitis. There are three proposed mechanisms for their development: firstly, inflammation and activated pancreatic lytic enzymes; secondly, pressure necrosis from a contiguous mass; thirdly, localized portal hypertension. Classically, pancreatic-colonic fistulas present with diarrhea, fever and hematochezia. Gastrointestinal bleeding occurs in 60% of cases. The source of bleed has been described to be originating most commonly from the splenic artery and to a lesser extent, the margin of the fistula or, rarely, erosion of splenic parenchyma. Reported therapeutic management strategies include: hemoclippings and Greenplast sprayings, endoscopic pancreatic stent, transgastric nasocystic drainage catheter placements, injection of N-butyl-2-cyanocrylate and transpapillary nasopancreatic drainage. Pseudocysts arise in 25% of patients with chronic pancreatitis. Pseudocysts may regress through a variety of mechanisms: spontaneously after inflammation from pancreatitis resolves, natural drainage through the pancreatic duct into the duodenum, or through a complicating fistulous tract connecting to the gastrointestinal tract. Rarely, the pseudocyst can resolve as it leaks or perforates into the abdominal cavity. Pancreatic pseudocysts may perforate spontaneously into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, or through the abdominal wall. We report the first case, to our knowledge, of pancreatic pseudocyst perforation post-clipping of bleeding pancreatic-colonic fistula. Funding Agencies None

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Lattanzi, Barbara, Ingrid Febbraro, Eliseo Pironti, and Marco Bianchi. "Successful Treatment of Pancreatic Pseudocysto-Duodenum Fistula with Ultrasound Endoscopic Drainage: A Case Report." International Journal of Translational Medicine 2, no. 4 (November 3, 2022): 537–42. http://dx.doi.org/10.3390/ijtm2040040.

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Pancreatic pseudocysts represent a complication of acute interstitial edematous pancreatitis with a frequency of about 10–20%, and most of these resolve spontaneously. Treatment is indicated only in patients who develop symptoms such as abdominal pain, gastric outlet obstruction, jaundice for compression of the biliary system, or in case of infection. Pancreatic pseudocysts’ complications include pseudocyst infection leading to sepsis, rupture with pancreatic ascites, bleeding or formation of pseudoaneurysm, and, rarely, fistulization to other viscera. The most common sites for fistulas are between cysts and the stomach, duodenum, and colon. Here, we present the case of a patient with severe acute pancreatitis who developed multiple infected fluid collections with a cysto-duodenum fistula that was successfully treated with endoscopic intervention.

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