External Pancreatic Fistula Following Abdominal Injury

Baker, Robert J.; Bass, Robert T.; Zajtchuk, Rostick; Strohl, E. Lee

doi:10.1001/archsurg.1967.01330160026004

Cited by 30 publications

(19 citation statements)

References 19 publications

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“…External pancreatic fistula occurs in around 4%–6% of patients after surgical intervention involving the pancreas and in around 33% after trauma . The success rate of conservative management of pancreatic fistulae is around 70% .…”

Section: Discussionmentioning

confidence: 99%

Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy

Komatsu

Sonoyama

Ochiai

et al. 2008

J Hepatobiliary Pancreat Surg

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Despite recent technological advances in the treatment of hepatobiliary pancreatic disease, intractable external pancreatic fistula is still a major critical complication after pancreaticoduodenectomy, and the treatment strategy is not well defined. We report here a case that was successfully treated by our novel interventional internal drainage technique. A 62-year-old woman underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the papilla of Vater, with reconstruction by a modified Child's procedure. One year later, she was readmitted to our hospital because of external pancreatic fistula. Both computed tomography and fistulography demonstrated a pancreatic fistula derived from dehiscence of the pancreatico-jejunal anastomosis. The pancreatic fistula persisted for 1 week with conservative management. Therefore, we performed repeated fistulography and cannulation, using two comparatively stiff guidewires introduced into the main pancreatic duct and stenotic anastomosed jejunal lumen, respectively, and we placed an endoprosthesis, using bilateral guidewires to connect the two lumens. Consequently, the pancreatic fistula was successfully closed within a few days. Our novel technique is simple, rapid, and not costly. Therefore, it should be considered an effective treatment strategy for persistent pancreatic fistula following pancreaticoduodenectomy that fails to respond to initial conservative management and an endoscopic approach. Also, this technique is applicable to other intractable fistulous situations.

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Section: Discussionmentioning

confidence: 99%

Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy

Komatsu

Sonoyama

Ochiai

et al. 2008

J Hepatobiliary Pancreat Surg

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show abstract

“…While the incidence of EPF is 4 ± 6 % after pancreatic surgery, it increases to 33 % in cases of surgery for abdominal injury [14,15]. Although some patients respond to conservative management, others might require endoscopic drainage [16] or surgical Roux-en-Y pancreaticojejunostomy, fistulojejunostomy, or distal pancreatectomy when the tail of the pancreas is affected [15,17] (Table 2).…”

Section: Discussionmentioning

confidence: 99%

External Pancreatic Fistulas Resistant to Conventional Endoscopic Therapy: Endoscopic Closure With N-Butyl-2-Cyanoacrylate (Glubran 2)

et al. 2004

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External pancreatic fistulas may follow abdominal surgery or injury. While most respond to conservative management or endoscopic intervention, others might require surgery for complete healing. We report four cases of patients with external pancreatic fistulas that failed to respond to conservative management and drainage. N-butyl-2-cyanoacrylate surgical glue (Glubran 2) was directly injected into the fistulous tract. The fistulas closed within 24 hours of the Glubran 2 injection in three cases (75 %). In patients with external pancreatic fistulas that fail to respond to conservative and endoscopic drainage, injection of Glubran 2 directly into the fistulous tract may lead to closure, thus avoiding the need for surgical intervention.

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“…The incidence of postoperative pancreatic fistula is reported to be between 4% and 52%, depending on the etiology and definition used [1,9,15,19,20]. External fistulas occur in 4-6% of patients after surgical interventions on the pancreas [1] and in 33% after trauma [9].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of pancreatic fistulas secondary to intraabdominal operation

et al. 2004

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External Pancreatic Fistula Following Abdominal Injury

Cited by 30 publications

References 19 publications

Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy

Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy

External Pancreatic Fistulas Resistant to Conventional Endoscopic Therapy: Endoscopic Closure With N-Butyl-2-Cyanoacrylate (Glubran 2)

Endoscopic management of pancreatic fistulas secondary to intraabdominal operation

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