Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis
G. G. Tsiotos, C. D. Smith and M. G. Sarr
Department of Surgery, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minn.
OBJECTIVE: To determine the incidence, type, and outcome of complications
of necrotizing pancreatitis. SETTING: Major tertiary referral center (Mayo
Clinic, Rochester, Minn). PATIENTS: Sixty-one patients seen from 1985 to
1994 who underwent surgical management of severe necrotizing pancreatitis
and who developed pancreatic or gastrointestinal fistulas. MAIN OUTCOME
MEASURES: Incidence, management, and outcome of pancreatic and
gastrointestinal fistulas. RESULTS: Twenty-five patients (41%) developed
pancreatic (14 patients) and/or gastrointestinal tract cutaneous (19
patients) fistulas. While three duodenal fistulas and one colonic fistula
were recognized at the initial operation for pancreatic necrosectomy, the
remainder developed 4 to 60 days after the initial operation. Spontaneous
closure occurred in nine of 14 pancreatic, two of two gastric, two of four
enteric, two of eight colonic, and four of five duodenal fistulas.
Mortality of the group with fistulas was 24% (6/25) and was not different
from the mortality of the patients with necrotizing pancreatitis without
fistulas (28% [10/36]). CONCLUSIONS: Pancreatic and gastrointestinal tract
fistulas are common complications of surgical treatment of severe
necrotizing pancreatitis. Well-controlled gastric, pancreatic, and enteric
fistulas have the greatest likelihood of spontaneous closure. Duodenal and
colonic fistulas may need surgical intervention for control or repair.
Mortality in these patients parallels the mortality for severe necrotizing
pancreatitis.
