Effect of pancreatic necrosis configuration on the dynamics of external pancreatic fistulas after acute pancreatitis

Aim. To study the effect of the pancreatic necrosis configuration on the course and outcome of external pancreatic fistulas formed at the stage of acute pancreatitis.

Materials and methods. The authors studied the dynamics of external pancreatic fistulas existing from 2 to 143 months after invasive interventions for pancreonecrosis in 53 patients. Pancreonecrosis, its depth and configuration were diagnosed by means of CT scan.

Results. Pancreatic fistula closed in 30 out of 53 patients: all 10 patients with type 1 configuration in shallow (<50%) necrosis and all 5 patients with type 2 configuration, even in complete transverse necrosis. With deep necrosis of type 1, fistula closed in 15 out of 38 patients. The outflow of juice from the viable parenchyma distal to the necrosis was restored in 7 out of 15 patients. The process was performed by endoscopic recanalization of the duct through the necrotic zone at the stage of acute pancreatitis. The volume of parenchyma distal to the necrosis did not change in the follow-up period: 50.4 ± 19.9 cm3 and 40.7 ± 14.4 cm3 (p > 0.05). In 8 patients, the volume of functioning parenchyma distal to necrosis reduced from 20 ± 6.3 cm3 to 7.4 ± 2.7 cm3 (p < 0.001). In persistent pancreatic fistulas, 23 patients underwent resection and drainage interventions.

Conclusion. The type and depth of necrosis configuration, as well as the volume of functioning parenchyma distal to the necrotic zone should be considered to predict the dynamics of pancreatic fistula after pancreatic necrosis. Deep necrosis of the pancreatic parenchyma with type 1 configuration and large volume of viable parenchyma distal to the necrosis suggest a persistent pancreatic fistula. Endoscopic transpapillary recanalization of the pancreatic duct through the zone of deep necrosis at the stage of acute pancreatitis contributes to the closure of the pancreatic fistula and prevents long-term atrophy of distal and functioning pancreatic parenchyma. Shallow necrosis in type 1 configuration and necrosis in type 2 configuration in acute pancreatitis suggest rapid closure of the pancreatic fistula.

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