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Internal pancreatic fistula.

P A Lipsett1, J L Cameron

  • 1Department of Surgery, Johns Hopkins University, Baltimore, Maryland.

American Journal of Surgery
|February 1, 1992
PubMed
Summary
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Internal pancreatic fistulae, complications of inflammatory pancreatic disease, are best treated initially nonoperatively. If conservative management fails, surgical intervention offers an acceptable risk for managing these complex pancreatic conditions.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Surgical Gastroenterology

Background:

  • Internal pancreatic fistulae are known complications of inflammatory pancreatic disease.
  • These fistulae can lead to pancreatic ascites and pleural effusions, significantly impacting patient health.
  • Previous treatment strategies and outcomes were varied, necessitating a review of management approaches.

Purpose of the Study:

  • To evaluate the efficacy and safety of nonoperative versus operative management for internal pancreatic fistulae.
  • To analyze patient outcomes, including morbidity and mortality, associated with different treatment modalities.
  • To provide evidence-based recommendations for the initial management of pancreatic ascites and effusions.

Main Methods:

  • Retrospective review of 50 patients treated between 1963 and 1990 for internal pancreatic fistulae.

Related Experiment Videos

  • Analysis of initial conservative therapy (gastrointestinal rest, fluid drainage, anti-secretagogues) success rates.
  • Evaluation of outcomes for patients undergoing operative therapy, including surgical success and complications.

    • Main Results:

    • Initial conservative therapy was successful in 21 of 42 patients, with 5 deaths.
    • Operative therapy was performed in 24 patients, with one surgical failure and two early deaths.
    • Liver biopsy in 10 patients revealed cirrhosis in all cases, highlighting potential comorbidities.

    Conclusions:

    • Internal pancreatic fistulae management should prioritize initial nonoperative treatment.
    • Operative therapy is a viable option with acceptable morbidity and mortality when conservative measures fail.
    • Routine amylase and albumin testing of ascitic/pleural fluid is crucial for diagnosis and management, even in cirrhotic patients.