>Year 2001, Issue 4
Carlos Daniel Lever Rosas, García NLM, Cabello PR
Post-traumatic pancreatic fistula: Report of three cases
Cir Gen 2001; 23 (4)
PDF: 4. Kb.
Objective: To report on our experience in the treatment of three patients with post-traumatic pancreatic fistula.
Setting: Third level health care hospital.
Design: Description of cases.
Description of cases: Three male patients aged 19, 25, and 30 years. Two with blunt abdominal trauma and one with penetrating thoraco-abdominal wound caused by firearm. Pancreatic lesions were grade II and III, in the patient with thoraco-abdominal penetrating wound there were associated lesions in the diaphragm, spleen, stomach, duodenum, and liver. In two, amylase content in the liquid drained from the fistula was high (46,764 and 6,864 IU/L, respectively). All patients were subjected to abdominal tomography to assess the site and size of the collections. The three patients were initially treated conservatively through suppression of oral feeding, parenteral nutrition, and use of antimicrobial drugs. All three patients were subjected to surgery, two of them twice to perform distal pancreatectomy in one and drainage in all. No deaths occurred.
Conclusion: The initial treatment of patients with post-traumatic fistula must be conservative, if no response is obtained after 10 days then surgery is indicated.
||Pancreas, pancreatic fistulas.
Bradley EL 3rd, Young PR Jr, Chang MC, Allen JE, Baker CC, Meredith W, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg 1998; 227: 861-9.
Patton JH Jr, Fabian TC. Complex pancreatic injuries. Surg Clin North Am 1996; 76: 783-95.
Farrell RJ, Krige JE, Bornman PC, Knottenbelt JD, Terblanche J. Operative strategies in pancreatic trauma. Br J Surg 1996; 83: 934-7.
Takishima T, Sugimoto K, Hirata M, Asari Y, Ohwada T, Kakita A. Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations. Ann Surg 1997; 226: 70-6.
Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF Jr, Malangoni MA. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg 1997; 63: 598-604.
Young PR Jr, Meredith JW, Baker CC, Thomason MH, Chang MC. Pancreatic injuries resulting from penetrating trauma: a multi-institution review. Am Surg 1998; 64: 838-43; discussion 843-4.
Ridgeway MG, Stabile BE. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am 1996; 76: 1159-73.
Howard TJ, Stonerock CE, Sarkar J, Lehman GA, Sherman S, Wiebke EA, et al. Contemporary treatment strategies for external pancreatic fistulas. Surgery 1998; 124: 627-32; discussion 632-3.
Kozarek RA, Traverso LW. Pancreatic fistulas: etiology, consequences, and treatment. Gastroenterologist 1996;4: 238-44.
Sato N, Yamaguchi K, Chijiiwa K, Tanaka M. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 1998; 133: 1094-8.
Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z´Graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg 2000; 87: 883-9.
Traverso LW, Kozarek RA. Interventional management of peripancreatic fluid collections. Surg Clin North Am 1999; 79: 745-57, VIII-IX.
Safadi BY, Marks JM. Pancreatic-pleural fistula: the role of ERCP in diagnosis and treatment. Gastrointest Endosc 2000; 51: 213-5.
Roder JD, Stein HJ, Bottcher KA, Bush R, Heidecke CD, Siewert JR. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann Surg 1999; 229: 41-8.
Fabre JM, Bauret P, Prudhomme M, Quenet F, Noel P, Baumel H, et al. Posttraumatic pancreatic fistula cured by endoprosthesis in the pancreatic duct. Am J Gastroenterol 1995; 90: 804-6.
Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000; 232: 419-29.
Nwariaku FE, Terracina A, Mileski WJ, Minei JP, Carrico CJ. Is octreotide beneficial following pancreatic injury? Am J Surg 1995; 170: 582-5.
Gómez J, Gallego P, Cobo J, Medraño JC, Molina F. Tratamiento con somatostatina en la ascitis pancreática. Rev Clin Esp 1992; 190: 352-3.
Vega Sáenz JL, Cosme Jiménez A, García Bengoechea M, Alzate Sáenz de Heredia LF, López López P, Arenas Miravé JI. La somatostatina en el tratamiento de la ascitis pancreática. Rev Esp Enf Digest 1993; 84: 273-5.
Magaña Sánchez IJ, Belmonte Montes C, Noyola Villalobos H, Cabello Pasini R. Traumatismo pancreato-duodenal combinado. Cir Gen 2000; 22: 226-31.
>Year 2001, Issue 4