Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: Recognition and management

Kaman, Lileswar; Behera, Arunanshu; Singh, Rajinder; Katariya, RN

doi:10.1046/j.1440-1622.2001.02077.x

Cited by 68 publications

(54 citation statements)

References 15 publications

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“…[3][4][5][6][7][8] The male to female ratio is 6 :1 which was similar to Cameron J et al series. 1,7 In our series 12 (85.7%) patients are chronic alcoholics.…”

Section: Discussionsupporting

confidence: 72%

Surgical management of pancreatic ascites

et al. 2017

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Background: Pancreatic ascites is a challenging problem faced by clinicians. The management requires a multidisciplinary approach. Timely surgical intervention is the key especially in patients with chronic pancreatitis and pancreatic ascites where conservative and endoscopic treatments were not successful.Methods: The data was retrieved from a prospectively maintained database for a period of 4 years. A total of 14 patients were included. They were initially optimized with ascitic fluid drainage, nutritional supplementation either enteral or parenteral. Endoscopic retrograde cholangio pancreatography (ERCP) was done in patients with failed conservative treatment after 2 weeks. Endoscopic pancreatic stenting was attempted in proximal ductal disruptions. Nonresponders were taken up for surgery. The type of surgery was based on the site of leak and associated pancreatic pathology like pseudocyst.Results: Initially three patients were responded to conservative management. ERCP was done in 9/14 patients. ERCP demonstrated leak of contrast into peritoneal cavity in 3 (3/9), leaking pancreatic pseudocyst in 3 (3/9) and non-visualisation of distal duct in 2 (2/9). ERCP and stenting of pancreatic duct was attempted in three patients and was successful in resolution of symptoms in one. Nine out of fourteen needed surgical intervention. Surgery was based on site of leak and presence of pseudocyst.Conclusions: Majority of the patients in our study were ethanolics and a change in life style early in the course can prevent this morbid disease. Nasojejunal tube feeding with blendarized home feeds will improve the nutritional status. CECT abdomen and ERCP will give a road map in deciding the type of intervention. For proximal ductal disruption endoscopic stenting should be tried before going for a major surgical intervention. Surgery provides definitive cure.

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“…[3][4][5][6][7][8] The male to female ratio is 6 :1 which was similar to Cameron J et al series. 1,7 In our series 12 (85.7%) patients are chronic alcoholics.…”

Section: Discussionsupporting

confidence: 72%

Surgical management of pancreatic ascites

et al. 2017

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“…Some reports have shown that the diagnostic sensitivity of MRCP is almost the same as that of ERCP and is higher than that of CT [21][22][23] . Our previous report found that a precise assessment of the pancreatic ductal system is essential for effectively managing patients with IPF; MRCP can be a promising tool for evaluating the pancreatic duct system, and it is also helpful for selecting the optimal treatment strategy 24) .…”

Section: Discussionmentioning

confidence: 95%

“…The disruption of the pancreatic duct results in the formation of internal fistula communicating with peritoneal or pleural cavities, which result in ascites or pleural effusion, respectively 5,16) . In most cases, IPF has been reported to develop secondary to alcoholic chronic pancreatitis [17][18][19][20][21] . In the present study, all patients presented pancreatic ascites or pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system

Tanaka¹,

Kuroki²,

Kitasato³

et al. 2013

Pancreatology

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Abstract[Background]Internal pancreatic fistula (IPF) is a well-recognized complication of pancreatic diseases. Although there have been many reports concerning IPF, the therapy for IPF still remains controversial. We herein report our experiences with endoscopic transpapillary pancreatic stent therapy for IPF and evaluate its validity.[Method]Six patients with IPF who presented at our department and received endoscopic transpapillary pancreatic stent therapy were investigated, focusing on the clinical and imaging features as well as treatment strategies, the response to therapy and the outcome.[Results]All patients were complicated with stenosis or obstruction of the main pancreatic duct, and in these cases the pancreatic ductal disruption developed distal to the areas of pancreatic stricture. The sites of pancreatic ductal disruption were the pancreatic body in five patients and the pancreatic tail in one patient. All patients received endoscopic stent placement over the stenosis site of the pancreatic duct, and three patients improved completely and one patient improved temporarily. Finally, three patients underwent [Conclusion]Endoscopic transpapillary pancreatic stent therapy may be an appropriate first-line treatment to be considered before surgical treatment. The point of stenting for IPF is to place a stent over the stenosis site of the pancreatic duct to reduce the pancreatic ductal pressure and the pseudocyst's pressure.

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“…El derrame pleural no es un diagnóstico específico en sí y su presencia en pacientes con antecedentes de alcoholismo, pancreatitis aguda o crónica, puede sugerir la posibilidad diagnós-tica de pseudoquiste pancreático complicado y una eventual mala evolución del proceso (5). El estudio diagnóstico está dirigido al reconocimiento de las vías de comunicación entre pán-creas y cavidad pleural y la topografía de las lesiones, con el fin de adoptar una correcta actitud terapéutica y un adecuado control evolutivo.…”

Section: Discussionunclassified

“…El estudio diagnóstico está dirigido al reconocimiento de las vías de comunicación entre pán-creas y cavidad pleural y la topografía de las lesiones, con el fin de adoptar una correcta actitud terapéutica y un adecuado control evolutivo. La estancia hospitalaria de estos pacientes puede ser prolongada (5 …”

Section: Discussionunclassified

Comunicación pancreático-pleural secundaria a pseudoquiste pancreático: Una complicación de evolución variable

Díaz

Parga

Cardamas

et al. 2008

Rev. esp. enferm. dig.

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Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: Recognition and management

Abstract: Internal pancreatic fistulas should be treated initially non-operatively; if this is not effective, operative therapy should be considered without delay.

Cited by 68 publications

References 15 publications

Surgical management of pancreatic ascites

Surgical management of pancreatic ascites

Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system

Comunicación pancreático-pleural secundaria a pseudoquiste pancreático: Una complicación de evolución variable

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