Management of Pancreatic Fistula in Acute Pancreatitis

Kaiser, Jörg; Hackert, Thilo; Büchler, Markus W.

doi:10.1002/9781119188421.ch37

Cited by 2 publications

(8 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Oncologic staging should evaluate the resectability, and treatment options should be discussed in a multidisciplinary team meetings. Neo-adjuvant chemotherapy may increase the rate of R0 resection in cases of borderline or LA PDAC [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Massive Haematochezia due to Splenic Artery Bleeding into the Colon: Unusual Manifestation of Advanced Pancreatic Cancer

Sguinzi

Pugin

Bader

et al. 2023

Case Reports in Surgery

View full text Add to dashboard Cite

We describe a case of an uncommon early pancreatic cancer presentation in a patient in his 60s who had haemorrhagic shock from extensive haematochezia and required blood transfusions as well as surveillance in an intensive care unit. A splenic artery pseudoaneurysm that had been effectively embolized by angiography was seen to be actively bleeding into the colon lumen on a computerized tomography (CT) scan along with a necrotic mass of the pancreatic tail. A pancreatic mucinous adenocarcinoma was diagnosed by a transgastric biopsy. A pancreatico-colic fistula was discovered by CT scan after a colic contrast enema. A transabdominal drainage of the necrotic collection and targeted antibiotic treatment had been performed with a satisfying patient outcome. In order to assess a potential secondary surgical resection, systemic chemotherapy was planned. In conclusion, haematochezia with hemodynamic instability originated from a splenic artery pseudoaneurysm fistulising into the colon (arterio-colic fistula) and sepsis originating from a tumoral pancreatic abscess fistulising into the colon (tumoral pancreatico-colic fistula).

show abstract

Section: Discussionmentioning

confidence: 99%

Massive Haematochezia due to Splenic Artery Bleeding into the Colon: Unusual Manifestation of Advanced Pancreatic Cancer

Sguinzi

Pugin

Bader

et al. 2023

Case Reports in Surgery

View full text Add to dashboard Cite

show abstract

“…In comparison with IPN patients without GIF, IPN patients with GIF had higher acute physiology and chronic health evaluation II score (11.8 vs 14.5, P < 0.01) and multiple organ dysfunction score (2.0 vs 3.0, P = 0.01) (6). Similarly, in a study of 244 patients with SAP, on multivariate logistic analysis, the risk of GIF was 3-fold higher in patients with IPN (odds ratio [OR (5,6,16)] 3.01; 95% confidence interval [CI] 1.69–15.02, P = 0.004). Other risks included high-modified computed tomography (CT) severity index (OR 1.18; 95% CI 1.09–2.55, P = 0.03) and possibly B-blood type (OR 1.006; 95% CI 0.74–3.56, P = 0.04) (5).…”

Section: Risks and Associationsmentioning

confidence: 93%

“…The major risk factors for internal PF include male sex, alcohol abuse, degree of severity of AP, and infected pancreatic necrosis (IPN) (3)(4)(5)(6). A significant male preponderance has been reported in various PF studies, ranging from 60% to 100% (5,6,10,11,16,17). Alcohol use has been associated with development of both GIF and PPF in 70%-83% of cases in early series (3,7).…”

Section: Risks and Associationsmentioning

confidence: 99%

“…In a study of 12 patients with GIFs, 7 (58.0%) presented with GI bleeding (11). Additional signs of GIFs include vomiting of necrotic, feculent, or purulent material, diarrhea with or without blood, or persistent sepsis (11,12,16). Most GIFs are diagnosed beyond 4-8 weeks after the onset of AP (4)(5)(6)12).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…In patients with IPN, intravenous antibiotics with efficacy on gut-derived bacteria and good penetration into the pancreas should be given. Patients with symptomatic or infected pancreatic fluid collections will benefit from welltimed drainage, and this may in turn decrease the risk of PF (5,16,27). Early initiation of EN helps to preserve gut mucosal integrity, inhibit bacterial translocation, and decrease systemic inflammation and risk of infection (5,27).…”

Section: Medical Management Of Pfmentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous Internal Pancreatic Fistulae Complicating Acute Pancreatitis

et al. 2021

View full text Add to dashboard Cite

Spontaneous pancreatic fistula (PF) is a rare but challenging complication of acute pancreatitis (AP). The fistulae could be internal (draining into another viscera or cavity, e.g., pancreaticocolonic, gastric, duodenal, jejunal, ileal, pleural, or bronchial) or external (draining to skin, i.e., pancreaticocutaneous). Internal fistulae constitute the majority of PF and will be discussed in this review. Male sex, alcohol abuse, severe AP, and infected necrosis are the major risk factors for development of internal PF. A high index of suspicion is required to diagnose PF. Broad availability of computed tomography makes it the initial test of choice. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography have higher sensitivity compared with computed tomography scan and also allow for assessment of pancreatic duct for leak or disconnection, which affects treatment approaches. Certain complications of PF including hemorrhage and sepsis could be life-threatening and require urgent intervention. In nonurgent/chronic cases, management of internal PF involves control of sepsis, which requires effective drainage of any residual pancreatic collection/necrosis, sometimes by enlarging the fistula. Decreasing fistula output with somatostatin analogs (in pancreaticopleural fistula) and decreasing intraductal pressure with endoscopic retrograde cholangiopancreatography or endoscopic ultrasound/interventional radiology–guided interventions or surgery are commonly used strategies for management of PF. More than 60% of the internal PF close with medical and nonsurgical interventions. Colonic fistula, medical refractory-PF, or PF associated with disconnected pancreatic duct can require surgical intervention including bowel resection or distal pancreatectomy. In conclusion, AP-induced spontaneous internal PF is a complex complication requiring multidisciplinary care for successful management.

show abstract

Management of Pancreatic Fistula in Acute Pancreatitis

Cited by 2 publications

References 49 publications

Massive Haematochezia due to Splenic Artery Bleeding into the Colon: Unusual Manifestation of Advanced Pancreatic Cancer

Massive Haematochezia due to Splenic Artery Bleeding into the Colon: Unusual Manifestation of Advanced Pancreatic Cancer

Spontaneous Internal Pancreatic Fistulae Complicating Acute Pancreatitis

Contact Info

Product

Resources

About