Traumatic pancreatic fistula in children: early management with a somatostatin analogue and drainage

Abstract

The management of a high-output pancreatic fistula is often difficult, and can be even more challenging in the pediatric patient. Octreotide acetate (OA) (Sandostatin, Sandoz, East Hanover, NJ) has served to facilitate the treatment of this difficult problem, but experience has been limited to adults. Somatostatin is a hormone that decreases the production of pancreatic exocrine and endocrine secretions. The use of the long-acting somatostatin analogue, OA, has reduced pancreatic fistula output and facilitated resolution of pancreatic fistulae in adults. This report summarizes the IV use of OA and external drainage in the complete resolution of high-output traumatic pancreatic fistulae in three pediatric patients. The treatment was well tolerated without side effects, and resulted in a dramatic decrease in the amount of fistula drainage within the first 24 to 48 h. OA can be safely administered IV (5-10 μg/kg per day) and is valuable in the management of traumatic pancreatic fistula in children.

Laparoscopic Treatment of a Pancreaticocutaneous Fistula

“…11 The use of octreotide acetate, a long-acting somatostatin analog, has been successful in the treatment of 5 cases of persistent posttraumatic fistulas in children. [12][13][14] Octreotide functions to reduce pancreatic exocrine and endocrine function and reduce splancnic blood flow. Octreotide has been less successful in the management of postsurgical fistulas, especially when the fistula is combined with a major ductal injury.…”