Pancreatic fistulas: Management
- Santhi Swaroop Vege, MD
Santhi Swaroop Vege, MD
- Professor of Medicine
- Mayo Clinic
- Michael L Kendrick, MD
Michael L Kendrick, MD
- Associate Professor of Surgery
- Mayo Clinic College of Medicine
- Section Editors
- David C Whitcomb, MD, PhD
David C Whitcomb, MD, PhD
- Section Editor — Pancreatic Diseases
- Professor of Medicine
- University of Pittsburgh School of Medicine
- Stanley W Ashley, MD
Stanley W Ashley, MD
- Section Editor — Pancreatic and Hepatobiliary Surgery
- Chief Medical Officer and Senior Vice President for Clinical Affairs
- Brigham and Women’s Hospital
- Frank Sawyer Professor of Surgery
- Harvard Medical School
A pancreatic fistula is characterized by leakage of pancreatic fluid as a result of disruption of pancreatic ducts. Disruption of pancreatic ducts can occur following acute or chronic pancreatitis, pancreatic resection, or trauma. Leakage of pancreatic secretions can cause significant morbidity due to malnutrition, skin excoriation, and infection. Successful management of pancreatic fistulas requires a multidisciplinary approach .
This topic will review the management of pancreatic fistulas. The clinical features, diagnosis, and prevention of pancreatic fistulas and the management of walled-off pancreatic fluid collections, infected pancreatic necrosis, and pancreatic trauma are discussed separately. (See "Pancreatic fistulas: Clinical manifestations and diagnosis" and "Walled-off pancreatic fluid collections (including pseudocysts)" and "Endoscopic management of walled-off pancreatic fluid collections: Techniques" and "Endoscopic management of walled-off pancreatic fluid collections: Efficacy and complications" and "Pancreatic debridement" and "Management of duodenal and pancreatic trauma in adults".)
DEFINITION AND CLASSIFICATION
A pancreatic fistula (PF) is defined as an abnormal connection between the pancreas and adjacent or distant organs, structures, or spaces (image 1).
PFs are classified as internal if the pancreatic duct communicates with the peritoneal or pleural cavity or another hollow viscus and external if the pancreatic duct communicates with the skin (table 1). PFs can also be classified based upon the underlying disease process and the immediate predisposing cause. (See "Pancreatic fistulas: Clinical manifestations and diagnosis", section on 'Definition and classification'.)
The management of pancreatic fistulas (PFs) depends on the presence of symptoms (eg, abdominal pain, fever, chills, jaundice, or early satiety), the characteristics and location of the fluid collection on imaging (eg, presence of pancreatic necrosis, proximity to the bowel lumen), and the presence of associated complications (eg, infection of pancreatic fluid). (See "Pancreatic fistulas: Clinical manifestations and diagnosis", section on 'Diagnostic evaluation'.)
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