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Results for “PANCREATIC FISTULA”

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At least 19 recordsLinked to original sources
PubMed1976

Internal pancreatic fistulas: pancreatic ascites and pleural effusions.

Thirty-four patients seen over a 10-year period with internal pancreatic fistulas are reported. In 22 patients the fistula was into the peritoneal cavity and they presented with pancreatic ascits. In 7 patients the fistula tracked up through the mediastinum into a pleural cavity, and they presented with pancreatic pleural effusions. Five patients presented with both pancreatic ascites and pancreatic pleural effusions. Diagnosis was made by finding a markedly elevated amylase and protein content in the ascitic and pleural fluids. Serum amylase was usually, but not always, elevated. Over one half of the patients had no history of inflammatory pancreatic disease. Initial treatment was non-operative using nasogastric suction, diamox, atropine, and multiple paracenteses or thoracenteses. This was successful in 48% (12/25). If non-operative therapy failed, surgery was performed to drain or resect the internal fistula. Surgery was successful in 82% (14/17). The internal pancreatic fistula was successfully demontrated in most instances by preoperative, operative, or postmortem pancreatography, or by gross observation at the time of surgery.

Adolescent↗
PubMed1998

Risk analysis of pancreatic fistula after pancreatic head resection.

OBJECTIVE: To evaluate the risk factors for pancreatic fistula after pancreatic head resection. DESIGN: Retrospective review. SETTING: University hospital, in the 71-month period from January 1992 through November 1997. PATIENTS AND INTERVENTION: Sixty-two patients who underwent pancreatic head resection with pancreatojejunostomy. We performed an extensive analysis of preoperative and perioperative risk factors for pancreatic fistula. MAIN OUTCOME MEASURES: Pancreatic fistula was defined as high amylase level (> 1000 U/L) in the drainage fluid collected from the peripancreatic drains and/or anastomotic disruption demonstrated radiographically. RESULTS: Nine (15%) of the 62 patients developed pancreatic fistula, and 1 (1.6%) died of intra-abdominal hemorrhage related to the pancreatic fistula. A preoperative normal N-benzoyl-L-tyrosyl-p-aminobenzoic acid test result (P=.01), soft or intermediate pancreatic consistency (P=.04), duodenum-preserving pancreatic head resection for the normal exocrine pancreas (P=.002), and a larger amount of postoperative pancreatic juice output (P=.02) were significant risk factors for pancreatic fistula formation. CONCLUSIONS: Careful attention should be paid to the preoperative exocrine pancreatic function, pancreatic consistency at surgery, and postoperative pancreatic juice output to predict and prevent pancreatic fistula after pancreatic head resection.

Adult↗
PubMedDate not supplied

[Transcholedochal pancreatic fistula].

Pancreatic fistula is usually caused by acute or chronic pancreatitis, injury and operations of the pancreas. The pancreatic juice comes either from the main pancreatic duct or from side branches. Extremely rare pancreatic fistula may come through the distal end of the common bile duct that is not properly sutured or ligated after traumatic or operative transsection. We present a 58-year old man who developed a life threatening high output pancreatic fistula through the distal end of the common bile duct that was simply ligated after resection for carcinoma. Pancreatic fistula was developed two weeks after original surgery and after two emergency reoperations for serious bleeding from the stump of the right gastric artery resected and ligated during radical lymphadenectomy. The patient was treated conservatively by elevation of the drainage bag after firm tunnel round the drain was formed so that there was no danger of spillage of the pancreatic juice within abdomen.

Biliary Fistula↗
PubMed1996

Surgical management and treatment of pancreatic fistulas.

Pancreatic fistulas most commonly derive as complications of elective surgical procedures on the pancreas and as sequelae of pancreatitis or pancreatic trauma. The majority of external pancreatic fistulas can be managed nonoperatively, with an expected rate of closure exceeding 80%. Internal fistulas are somewhat less likely to close with conservative measures alone. Octreotide has been shown to significantly reduce fistula output and to hasten the closure of both internal and external pancreatic fistulas without affecting the overall rates of closure. Operative therapy is reserved for the treatment of fistulas that do not respond to conservative medical management. In randomized prospective trials, prophylactic octreotide has been shown to reduce the morbidity of elective pancreatic resections with respect to overall complication and fistula formation rates. Surgical experience and technique appear to be the most important factors in determining the overall complication rates following elective pancreatic surgery.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2000

Pancreatic fistula after pancreatic head resection.

BACKGROUND: Pancreatic resections can be performed with great safety. However, the morbidity rate is reported to be 40-60 per cent with a high prevalence of pancreatic complications. The aim of this study was to analyse complications after pancreatic head resection, with particular attention to morbidity and pancreatic fistula. METHODS: From November 1993 to May 1999, perioperative and postoperative data from 331 consecutive patients undergoing pancreatic head resection were recorded prospectively. Data were analysed and grouped according to the procedure performed: classic Whipple resection, pylorus-preserving pancreatoduodenectomy (PPPD) or duodenum-preserving pancreatic head resection (DPPHR). RESULTS: Pancreatic head resection had a mortality rate of 2.1 per cent; the difference in mortality rate between the three groups (0.9-3.0 per cent) was not significant. Total and local morbidity rates were 38.4 and 28 per cent respectively. DPPHR had a lower morbidity, both local and systemic, than pancreatoduodenectomy. The prevalence of pancreatic fistula was 2.1 per cent in 331 patients, and was not dependent on the procedure or the aetiology of the disease. Reoperations were performed in 3.9 per cent of patients, predominantly for bleeding and non-pancreatic fistula. None of the patients with pancreatic fistula required reoperation or died in the postoperative course. CONCLUSION: A standardized technique and a continuing effort to improve perioperative management may be responsible for low mortality and surgical morbidity rates after pancreatic head resection. Pancreatic complications occur with Whipple, PPPD and DPPHR procedures with a similar prevalence. Pancreatic fistula no longer seems to be a major problem after pancreatic head resection and rarely necessitates surgical treatment.

Adolescent↗
PubMed2001

Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management.

BACKGROUND: Internal pancreatic fistulas are well recognized complications of chronic pancreatitis. METHODS: Six patients with internal pancreatic fistulas were treated over a period of 5 years from 1995 to 1999. Four patients presented with ascites, one patient presented with ascites and bilateral pleural effusion and the sixth patient presented with left-sided pleural effusion. Five patients were chronic alcoholics and in one patient the cause of pancreatitis was not clear. Although the serum amylase was mildly elevated the levels of amylase in the aspirated fluid were consistently elevated (more than 800 Somogyi units/100 mL), along with the level of proteins (> or = 3 g/100 mL), and on this basis the diagnosis was made. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated pancreatic ductal disruption in four cases. Initial treatment was conservative, consisting of nasogastric aspiration, nil per oral, antisecretory drugs, repeated paracentesis or thoracocenthesis and total parenteral nutrition (TPN). In two patients naso-pancreatic drains (NPD) were placed across the disrupted pancreatic duct. RESULTS: In one patient conservative treatment with NPD was successful, and the remaining five patients required surgical intervention. There was no mortality. Two patients developed surgery-related complications that were successfully managed, but they required an extended hospital stay. CONCLUSION: Internal pancreatic fistulas should be treated initially non-operatively; if this is not effective, operative therapy should be considered without delay.

Abdominal Pain↗
PubMed2004

Endoscopic management of pancreatic fistula after pancreatic and other abdominal surgery.

Post-operative pancreatic fistulae represent a challenge for all the actors in gastroenterology: for surgeons, because they want to prevent and treat conservatively this complication since re-operation is associated with high morbidity and mortality rates; for radiologists, because they have to provide the best staging and informations without any additional risk; and for endoscopists, because endoluminal treatment is emerging as a safe and effective procedure provided it is performed in highly experienced tertiary centres in the setting of a multidisciplinary approach. Herein, we review the definitions, the causes, the staging and the possible options to prevent or treat post-operative pancreatic fistulae. Special attention is paid to the endoscopic management of this complication: including the relief of ductal obstructions, the stenting of leakages and the drainage of bulging or non-bulging fluid collections. Practical problems and issues are clearly outlined as well as the need for future improvements in staging and management of the patients having such complications.

Cholangiopancreatography, Magnetic Resonance↗
PubMedDate not supplied

Pancreatic fistula after pancreatic head resection; incidence, significance and management.

BACKGROUND/AIMS: Anastomotic leak at the pancreatojejunostomy remains a common and dreaded complication after pancreaticoduodenectomy. Our aim was to determine the incidence, presentation, methods of management, and preoperative and postoperative factors that influence the clinical outcome. METHODOLOGY: We reviewed our collective experience with 70 consecutive patients from 1985 to 2000 for a variety of pathologic indications. Clinical, biochemical, intraoperative and postoperative factors were reviewed in an attempt to determine prognostic factors. RESULTS: Nine patients (12%) developed a pancreatic anastomotic leak as determined by increased amylase in drainage fluid (70%), were clinically insignificant and were managed by simple maintenance of intraoperatively placed drains. Although octreotide was used therapeutically in 4 patients (44%), significant, objective response was noted in all patients. Of the clinical, biochemical, intraoperative and postoperative factors reviewed to determine prognostic factors, a large amount of postoperative pancreatic juice output (P = 0.02) was a significant risk factor for pancreatic fistula formation. CONCLUSIONS: We conclude that most anastomotic leak at pancreaticoenterostomy after pancreaticoduodenectomy can be managed conservatively. Use of octreotide to aid in closure of the pancreatic leak was satisfactory.

Drainage↗
PubMedDate not supplied

Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm; can pancreatic fistula be prevented?

BACKGROUND/AIMS: Pancreatic fistula is a potentially fatal complication in pancreatic surgery. The objective of this study was to analyze the incidence of pancreatic fistula in patients who underwent distal pancreatectomy for pancreatic neoplasm. METHODOLOGY: Forty-seven patients who underwent distal pancreatectomy for neoplasm of the pancreas at Kochi Medical School between October 1981 and December 2002 were studied. Comparative analysis was carried out to identify the correlations between the incidence of pancreatic fistula and parameters of preoperative evaluation, intraoperative procedure, and postoperative laboratory investigation. RESULTS: The incidence of pancreatic fistula in patients who underwent distal pancreatectomy for pancreatic neoplasm was 27.7%. Intraoperatively, the frequency of pancreatic fistula was significantly high in patients who underwent distal pancreatectomy without lymph node dissection and ligation of the splenic artery. No significant difference was recognized between the conventional surgical division and auto suture staple groups, however, in the ultrasonically activated scalpel (USAS) group, no pancreatic fistula was observed. A multivariate analysis revealed that independent high incidence of pancreatic fistula were 1) the situation of the tumor at pancreatic body, 2) the procedure of D2 lymph node dissection, and 3) the ligation of the root of splenic artery. In the group with the presence of pancreatic fistula, the serum amylase level on the first postoperative day was significantly higher than that in the group without fistula. CONCLUSIONS: Our findings supported that pancreatic fistula may be preventable by use of the USAS and treatment of acute pancreatitis in the early postoperative stage.

Adult↗
PubMed1980

Pancreatic ascites. Intraoperative localization of the pancreatic fistula.

Pancreatic ascites can be diagnosed by demonstration of high amylase concentration in the ascites and ERCP may serve to identify the causal internal fistula. Intraoperatively a precise localization of the ductal leakage is helpful. In two patients we demonstrated the fistulas by stimulation of the pancreatic secretion with secretin.

Adult↗
PubMed1995

Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial.

BACKGROUND: A prospective, randomized controlled clinical trial was conducted in 33 Italian surgical departments with the aim of evaluating the efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections. METHODS: Between July 1990 and May 1992, 278 patients were enrolled in the study. Fifty-four dropped out because of unresectable disease and six were excluded because of protocol violation; the remaining 218 were randomly assigned to the octreotide group (n = 111) or to the placebo group (n = 107). There were 131 men and 87 women with a mean age of 58.2 +/- 11.7 yrs. Pancreaticoduodenectomy was the most common operation performed (n = 143), sixty-four percent of patients had a pancreatic or periampullary cancer; chronic pancreatitis accounted for 8.2% of cases. RESULTS: Mortality rate was 6.9%. A pancreatic fistula occurred in 31 patients (14.2%), 9% in the octreotide group and 19.6% in the placebo group (p < 0.05). Morbidity rate was significantly lower in the octreotide (21.6%) than in the placebo group (36.4%) (p < 0.05). When specific pancreatic complications were grouped together and evaluated, they occurred less frequently in the treated (15.3%) than in the placebo group (29.9%) (p < 0.05). CONCLUSIONS: Octreotide was able to reduce significantly the incidence of pancreatic fistula after elective pancreatic resections.

Aged↗
PubMed1996

[Treatment of a pancreatic fistula after pancreatic transplantation using the obliterative technic].

The authors present the case-record of a patient after combined transplantation of the pancreas and kidney who developed a chronic duodenocutaneous fistula. The case was resolved by elimination of the duodenocystoanastomosis of the transplanted pancreas and by obliteration of the pancreatic duct of the graft by a polymer. One year after surgery the patient has no complaints and the function of both transplanted organs is satisfactory.

Adult↗
PubMed2004

Surgical treatment of pancreatic fistula.

BACKGROUND: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. AIMS: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. RESULTS: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. CONCLUSIONS: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90-92% but with a mortality of 6-9%.

Ascites↗
PubMed2003

Pancreatic fistula rate after pancreatic resection. The importance of definitions.

BACKGROUND: Pancreatic fistula (PF) is still regarded as a serious complication both in terms of frequency and sequelae. The incidence varies greatly in different reports because of the different definitions used. The aim of this study was to compare several definitions of PF encountered in the current literature and to demonstrate that the PF rate in the same group of patients treated in a high volume center is dependent upon the definition applied. METHODS: A Medline search of the last 10 years was performed as regards the definition of PF. A score was assigned to the reproducible definitions based upon two basic parameters: daily output (cm3) and duration of the fistula represented by the number of days between the postoperative day of onset and the duration of the complication. Four definitions were formulated and were then applied to a group of 242 patients that underwent pancreatic head or intermediate resections with pancreatico-jejunal anastomosis in our Pancreatic Unit between November 1996 and December 2000. Statistical analysis was carried out using the Yates correct chi2 test with statistical significance set at p < 0.05. RESULTS: Among 26 different definitions identified, 14 were found suitable for the applied score. We formulated four final definitions summarizing the current concepts of PF. The incidence of PF ranged between 9.9 and 28.5% according to the different definitions applied with highly statistical differences between them. CONCLUSIONS: The PF rate after pancreatic resections is strictly dependent upon the definition used. An overall general agreement for an internationally accepted definition is urgently needed to correctly compare different experiences.

Anastomosis, Surgical↗
PubMed1996

[External pancreatic fistulae].

External pancreatic fistulas are feared complications of pancreatic surgery or to trauma of the pancreas. In our paper we report on 2 patients suffering of external pancreatic fistulas successfully treated by operation. We demonstrate the examinations suitable for preoperative mapping of the fistula, the possibilities of conservative treatment and the strategy of surgical management of the fistulas. During the follow-up time the results of the operation are excellent.

Cutaneous Fistula↗