DIAGNOSTICS AND TREATMENT OF INTERNAL PANCREATIC FISTULA IN ACUTE PANCREATITIS

Aim. To study pancreatic changes in acute pancreatitis with internal pancreatic fistula and to assess the results of retroperitoneoscopic sanations for this pathology.

 Material and Methods. Contrast-enhanced CT was made in 30 patients. Localization and depth of necrosis were evaluated in sagittal, axial and coronal sections. Swelling and infiltration of retroperitoneal fat up to pelvic floor aperture were the criteria for evaluating severity of retroperitoneal fat lesion. All patients were divided into two groups. The first group included 15 patients with pancreatic head or isthmus necrosis and viable parenchyma of body and tail who underwent retroperitoneoscopic drainage of retroperitoneal fat in 4–5 hours after disease onset. The second group consisted of 15 patients with various forms of pancreatic necrosis who were operated only at the stage of infected pancreatic necrosis.

 Results. In the first group hospital-stay was 45 ± 5.3 days. External pancreatic fistula was observed in all patients that was closed within 4.8 ± 1.1 months after surgery. Deaths were absent. Postoperative ventral hernia was not observed. Pancreatic pseudocysts occurred in 3 (20%) patients. Mean hospital-stay in the second group was 80 ± 5.3 days, mortality rate – 33.3%. External pancreatic fistula formed in 2 (13%) patients, postoperative ventral hernia – in 3 (20%) cases, pancreatic pseudocyst – in 3 (20%) cases.

Conclusion. Contrast-enhanced computed tomography visualizes internal pancreatic fistula and gives information for differentiated surgical approach in acute pancreatitis patients. External drainage of retroperitoneal fat is pathogenetically proved treatment of patients with internal pancreatic fistula and acute severe pancreatitis. 

1. Sbornik metodicheskih materialov “Shkoly hirurgii Rossijskogo obshhestva khirurgov”. Ostryj pankreatit [Collection of teaching materials “School of surgery of Russian Surgeons Society”: acute pancreatitis]. Moscow, 2015. P. 94. (In Russian)

2. Dyuzheva T.G., Shaefer A.V. Abdominal hypertension in patients with severe acute pancreatitis. Khirurgiya. 2014; 1: 21–29. (In Russian)

3. Dyuzheva T.G., Dzhus E.V., Shaefer A.V. Akhaladze G.G., Chevokin A.Yu., Kotovsky A.E., Platonova L.V., Shono N.I., Galperin E.I. Pancreatic necrosis configuration and differentiated treatment of acute pancreatitis. Annaly khirurgicheskoy gepatologii. 2013; 18 (1): 92–102. (In Russian)

4. Bang J.Y., Navaneethan U., Hasan M.K., Hawes R.H., Varadarajulu S. EUS correlates of disconnected pancreatic duct syndrome in walled-off necrosis. Endosc. Int. Open. 2016; 4 (8): E883–889. DOI: 10.1055/s-0042-112586.

5. Li X., Zhuang L., Zhang X., Wang J., Chen T., Li L., Aduah E.A., Hu J. Preliminary study of MR diffusion tensor imaging of pancreas for the diagnosis of acute pancreatitis. PLoS One. 2016; 11 (9): e0160115. DOI: 10.1371/journal.pone.0160115.

6. Ishikawa K., Nakao S., Nakamuro M., Huang T., Nakano H. The retroperitoneal interfascial planes: current overview and future perspectives. Acute Medicine & Surgery. 2016; 3: 219–229. DOI: 10.1002/ams2.188.

7. Karpavicius A., Dambrauskas Z., Gradauskas A., Samuilis A., Zviniene K., Kupcinskas J., Brimas G., Meckovski A., Sileikis A., Strupas K. The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis. BMC Gastroenterol. 2016; 16 (1): 99. DOI: 10.1186/s12876-016-0514-4.

8. Ji L., Lv J.C., Song Z.F., Jiang M.T., Li L., Sun B. Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis. Hepatobiliary Pancreat. Dis. Int. 2016; 15 (4): 428– 433. DOI: 10.1016/S1499-3872(15)60043-1.

9. Nistal M., Zoltani M., Lohse A.W., Di Daniele N., Tesauro M., Pace A. Analysis of the power of common diagnostic tools in the management of acute pancreatitis. Gastroenterol. Res. Pract. 2014; 2014: 438697. DOI: 10.1155/2014/43.