What is a Pancreatic Fistula?

Last Updated on September 23, 2022 by amin


What is a Pancreatic Fistula?

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.Mar 30, 2021

What causes pancreatic fistulas?

Pathogenesis. Internal pancreatic fistulas are most commonly caused by disruption of the pancreatic duct due to chronic pancreatitis. The chronic pancreatitis is usually alcoholic in origin in adults, and traumatic in origin in children. They may also be caused by leakage from a pancreatic pseudocyst.

Can a pancreatic fistula heal itself?

It has a high self-healing rate and usually does not require surgery. Jejunal fistula can be cured by parenteral nutrition or enteral nutrition through feeding tube across the fistula orifice. Tube fistula can usually heal by itself.

What are the signs of pancreas problems?


  • Upper abdominal pain.
  • Abdominal pain that radiates to your back.
  • Tenderness when touching the abdomen.
  • Fever.
  • Rapid pulse.
  • Nausea.
  • Vomiting.

What fistula means?

(FIS-chuh-luh) An abnormal opening or passage between two organs or between an organ and the surface of the body. Fistulas may be caused by injury, infection, or inflammation, or may be created during surgery.

What happens if pancreatic fluid leaks?

The progression of pancreatic duct leak can result in the development of various clinical entities including pseudocyst formation, pleural effusion, ascites, and pancreatic fistulas. Among them, pancreatic pseudocyst is the most common, occurring in 30-40% of patients with chronic pancreatitis [1].

What is a intestinal fistula?

A gastrointestinal fistula is an abnormal opening in the stomach or intestines that allows the contents to leak. Leaks that go through to a part of the intestines are called entero-enteral fistulas. Leaks that go through to the skin are called enterocutaneous fistulas.

What causes a pancreas to leak?

Pseudocysts form when the cells of the pancreas become inflamed or are injured. Pancreatic enzymes start to leak. Leaking of the enzymes harms the tissue of the pancreas. Pancreatic pseudocysts are more common after an episode of sudden (acute) pancreatitis.

Are ascites painful?

Ascites is a condition in which fluid collects in spaces within your abdomen. If severe, ascites may be painful. The problem may keep you from moving around comfortably. Ascites can set the stage for an infection in your abdomen.

What is the survival rate for acute pancreatitis?

Acute pancreatitis is an inflammatory condition of the pancreas that is painful and at times deadly. Despite the great advances in critical care medicine over the past 20 years, the mortality rate of acute pancreatitis has remained at about 10%.

How is pancreatic leakage diagnosed?

The index test is used to test for pancreatic leak in an unselected population after pancreatic resection. It is usually followed by CT scan or magnetic resonance cholangiopancreatography (MRCP) to confirm the presence or absence of peripancreatic collection and pancreatic leak.

What is pancreatic necrosis?

Necrotizing pancreatitis (NP) is a health problem in which part of your pancreas dies. This is because of inflammation or injury. If the dead tissue gets infected, it can cause serious issues. The pancreas is an organ that sits behind your stomach. It makes fluids that flow through a duct into the small intestine.

What is the survival rate after Whipple surgery?

Overall, the five-year survival rate after a Whipple procedure is about 20 to 25%. Even if the procedure successfully removes the visible tumor, it’s possible that some cancer cells have already spread elsewhere in the body, where they can form new tumors and eventually cause death.

When should pancreatic drain be removed?

Conclusions: In patients at low risk of pancreatic fistula, intra-abdominal drains can be safely removed on POD 3 after standard pancreatic resections. A prolonged period of drain insertion is associated with a higher rate of postoperative complications with increased hospital stay and costs.

How do you treat a leaky pancreas after Whipple?

According to our experience, recommended approach for this condition includes pancreatic debridement, closing its stump, resection of extra parts of the jejunum, closing the jejunal stump and feeding tube jejunostomy. Complete drainage of the abdomen and nutritional support after the surgical intervention.

How serious is pancreatic surgery?

It carries a relatively high risk of complications that can be life threatening. When the operation is done in small hospitals or by doctors with less experience, as many as 15% of patients may die as a result of surgical complications.

What is chronic pancreatic?

Chronic pancreatitis is inflammation of the pancreas that does not heal or improveit gets worse over time and leads to permanent damage. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic hormones.

What can I expect after pancreatic surgery?

After pancreatic surgery, it is normal to have difficulty eating or to experience nausea, vomiting or heartburn. These symptoms are caused by a condition known as “gastric ileus,” or temporary paralysis of the stomach. It may take your digestive system anywhere from a few weeks to a few months to return to normal.

What color is pancreatic fluid?

Macroscopically, drain fluid that is red-brown in colour in the first few postoperative days is thought to be associated with enzymatic breakdown of intra-abdominal proteins caused by a leakage of protease-rich pancreatic fluid.

How long does it take for a pancreatic fistula to heal?

Fistulas were managed with gradual withdrawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas.

What foods should you avoid if you have chronic pancreatitis?

What not to eat if you have pancreatitis

  • red meat.
  • organ meats.
  • fried foods.
  • fries and potato chips.
  • mayonnaise.
  • margarine and butter.
  • full-fat dairy.
  • pastries and desserts with added sugars.

What doctor treats pancreatic cysts?

Gastroenterologists (digestive health physicians) who specialize in medically treating all kinds of pancreatic diseases, including cysts. Interventional gastroenterologists who specialize in nonsurgical approaches to diagnosing pancreatic cysts and other problems.

How do you drain fluid from the pancreas?

The majority of pancreatic fluid collections resolve spontaneously and do not require intervention. However, infection may require intervention. Interventions may include endoscopic or percutaneous catheter drainage, or in a next step endoscopic or surgical necrosectomy, minimally invasive or open.

Why is duodenum removed in Whipple?

A Whipple procedure also known as a pancreaticoduodenectomy is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct.

Where does fluid from pancreatitis accumulate?

Sometimes, sacs of fluid, called pseudocysts, can develop on the surface of the pancreas in people with acute pancreatitis. These can cause bloating, indigestion and dull tummy pain. They often disappear on their own but can sometimes get infected and may need to be drained.

What is the function of pancreas?

Your pancreas is important for digesting food and managing your use of sugar for energy after digestion. If you have any symptoms of pancreatic digestion problems, like loss of appetite, abdominal pain, fatty stools, or weight loss, call your healthcare provider.

Can you live without a pancreas?

Yes, you can live without a pancreas. You’ll need to make a few adjustments to your life, though. Your pancreas makes substances that control your blood sugar and help your body digest foods. After surgery, you’ll have to take medicines to handle these functions.

What is Whipple procedure used for?

The Whipple procedure (also called a pancreaticoduodenectomy) is the primary surgical treatment for pancreatic cancer that occurs within the head of the gland.

What is a fistula after pancreatic surgery?

Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage.

Can pancreatic cysts be drained?

Drainage. A pseudocyst that is causing bothersome symptoms or growing larger can be drained. A small flexible tube (endoscope) is passed through your mouth to your stomach and small intestine. The endoscope is equipped with an ultrasound probe (endoscopic ultrasound) and a needle to drain the cyst.

What is pancreatic secretion?

Pancreatic secretion is an aqueous solution of bicarbonate originating from the duct cells and enzymes originating from the acinar cells.

What is the life expectancy of someone with chronic pancreatitis?

The overall survival rate is 70% at 10 years and 45% at 20 years. In an international study, 559 deaths occurred among patients with chronic pancreatitis, compared with an expected number of 157, which creates a standard mortality ratio of 3.6.

Why does pancreatic fistula cause acidosis?

A small bowel fistula causes a metabolic acidosis by increasing the strong ion difference, due to the loss of a large amount of strong cations (sodium and potassium) with a relatively small loss of chloride.

What is amylase fluid?

Clinical Information Amylase might be measured in a drain fluid to aid in the identification of internal pancreatic fistulas due to chronic pancreatitis or formation of a fistula after surgery.