File name .JPG
File alt. text
Image should be px wide x px tall.
Select Image
home - Pancreas - Other - Pancreatic Fistula Presentation Written by Dr Sebastian Zeki

Pancreatic Fistula Presentation

Some get disconnected pancreatic duct syndrome (DPDS).Characterized by cutoff of main pancreatic duct during ERCP (most commonly in the neck or body) despite CT evidence of viable pancreatic tissue distal to the cutoff.Usually after episode of acute pancreatitis with necrosis of portion of the pancreas/ after pancreatic debridement.DPDS can also be assoc.with pancreatic fluid collections and lead to chronic pancreatitis and diabetes mellitus. Internal fistulasPancreatic duct disrupted, fluid collection forms which then erodes into adjacent organAetiology:Usually chronic pancreatitis with pseudocyst.Anterior erosion: Pancreatic ascites (ascitic amylase >4000 IU/mL)Posterior erosion: May track intopleural cavity/mediastinum. External fistulas (from the pancreas or peripancreatic fluid collection to the skin surface)Definition= Outputting drain after postop day 3 with an amylase content>3x serum amylase.Aetiology:Post pancreatic resection or drainage of pancreatic pseudocyst/abscess/necrosis. Pancreatic Fistulas- Causes:Pancreaticoduodenectomy-15%.Distal pancreatectomy-13%.Pancreatic trauma12%.Necrotizing pancreatitis surgery (15.4 to 76 %).Chronic pancreatitis surgery- 9%. Clinical Presentation of External Fistulas:Skin excoriation.High (>200 mL/day) or low output fistulas.Malnutrition and electrolyte imbalance, bleeding, and/or infection. Clinical Presentation of Internal Fistulas:Sepsis.Communications with colon, duodenum, biliary tree, PV.Pancreatic ascites- slow to develop and can have no to severe abdo pain.Pancreaticopleural, pancreaticobronchial, pancreaticomediastinal, or pancreatico-pericardial fistulas-have all been described. Somatostatin and its analoguesNo clear benefit for the two most common pancreatic operations, pancreaticoduodenectomy and distal pancreatectomy.Fibrin glue shows no clear benefit.Prophylactic pancreatic stenting- the role remains unclear. Pancreatic Fistulas Prevention Pancreatic juice exits through and breaks down abdominal wall Contents drain into duodenum Pancreatic duct Faecal matter can enter pancreas Colon External fistula Internal fistula Type of pancreaticojejunostomyTwo methods are used widely for creating an end-to-side pancreaticojejunostomy after pancreaticoduodenectomy; one method involves a duct to mucosa pancreaticojeju-nostomy while the other involves invagina-tion the pancreatic remnant into the jejunum.Whether the specific method of reconstru-tion after pancreatic resection contributes to rates of pancreatic fistula is still debated.