Treatment of Pancreatic Ascites and External Pancreatic Fistulas with a Long-Acting Somatostatin Analogue (Sandostatin)

Segal, I; Parekh, Dilipkumar; Lipschitz, Jeremy; Gecelter, Gary; Myburgh, J. A.

doi:10.1159/000201078

Cited by 33 publications

(20 citation statements)

References 8 publications

(13 reference statements)

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“…External pancreatic fistulas occurred after abdominal trauma, surgery to the pancreas, following catheter drainage of pseudocysts or as a complication of acute pancreatitis. Spontaneous closure was unusual, but octreotide therapy was highly efficacious, often achieving closure by 3 days; occasionally total parenteral nutrition was used as an adjuvant measure [18]. This experience concurs with that of others [19,20].…”

supporting

confidence: 84%

Pancreatitis in Soweto, South Africa

Segal

1998

Digestion

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Both acute pancreatitis and chronic pancreatitis now appear to be endemic at Soweto, South Africa, and they carry a substantial toll in terms of morbidity and mortality. Case-control studies identified the same three environmental factors in each disease, namely, heavy alcohol consumption, marked exposure to occupational chemicals and low intake of fruit (a major source of vitamin C). This congruity, and parallel trends on blood biochemical analysis indicating heightened free radical activity coupled with poor antioxidant status, suggest that the two diseases may be part of a pathobiological spectrum that is linked by pancreatic oxidant stress. Further, asymptomatic chronic alcoholics had plasma glutathione concentrations that were midway between the values in non-alcoholic controls and patients with chronic pancreatitis, being significantly different from each. And, finally, apparently healthy Sowetans were actually in a state of oxidant stress that was tied in with their very poor vitamin C status, and lower serum selenium concentrations than in the UK. These data, and evidence that both antioxidants mitigate against alcoholic toxicity in experimental studies, may offer scope for disease prophylaxis in this unprivileged community.

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confidence: 84%

Pancreatitis in Soweto, South Africa

Segal

1998

Digestion

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“…PD stents work by bypassing the pancreatic sphincter, thereby converting the normally high-pressure pancreatic ducts to a low pressure system with preferential flow through the stent, and thus facilitating spontaneous healing of the disruption site. [15][16][17] Management of PPF in the initial stages relies on optimization of fluid and electrolyte imbalance at presentation and is of paramount importance. These patients are usually malnourished at presentation and may have additional sodium bicarbonate deficiency due to large volume loss of pancreatic exocrine secretions.…”

Section: Discussionmentioning

confidence: 99%

Pleuropancreatic Fistulae: Specialist Center Management

Khan

Ching

Morris‐Stiff

et al. 2009

Journal of Gastrointestinal Surgery

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“…Initial treatment is conservative comprising nil by mouth, somatostatin analogue administration, abdominal drainage (or repeated paracentesis), insertion of a chest drain (or repeated thoracocentesis) and total parenteral nutrition or enteral nutrition distal to the ligament of Treitz, following which a substantial number (50–65%) of fistulae will close [103, 104, 105]. If conservative treatment fails, the next therapeutic option is endoscopic pancreatic stenting and although the data are mainly from case reports and very small series, the results are promising with success rates of up to 100% [55, 97, 106, 107, 108, 109, 110, 111](table 8).…”

Section: Internal Pancreatic Fistulae and Pancreatic Ascitesmentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

102

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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Treatment of Pancreatic Ascites and External Pancreatic Fistulas with a Long-Acting Somatostatin Analogue (Sandostatin)

Cited by 33 publications

References 8 publications

Pancreatitis in Soweto, South Africa

Pancreatitis in Soweto, South Africa

Pleuropancreatic Fistulae: Specialist Center Management

Surgical Treatment of Pancreatic Fistula

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