What is a pancreatic fistula?

Pancreatic fistula refers to an abnormal connection between the pancreatic and another organ or space caused by the leakage of strong pancreatic enzymes either from the damaged abdominal canal or from the pseudo -pitch of the pancreas. It usually occurs in conjunction with pancreatitis, but may also be a complication of surgical manipulation or abdominal trauma. This condition is usually treated by limiting food intake, administration of somatostatin analogues and in the worst case surgical or endoscopic treatment.

There are two main types of pancreatic fistula. The first is called the external pancreatic fistula or pancreatic -mutaneous fistula, which is called the abdominal and skin because of abnormal communication of the pancreas. Pancreatic sextics are rich in bicarbonate, a substance that helps maintain normal potensing (pH) blood. When a pancreatic fistula occurs, secretions rich in bicarbonates evaporate, resulting in acidosis or lowering the blood pH.

The second type is called inner pancreatiThe fistula is because the pancreas communicates with other intraabdominal organs or spaces. When secretion of pancreatic enters the peritoneal cavity, they are called ascity of the pancreas. If mediastinum or central thoracic compartment is affected, it is called enzymatic mediastinitis. In cases where the pleural lung coverage is affected, it is called pancreatic pleural effusion or pancreatico-full fistula.

pancreatitis or pancreatitis is the most common precedent of pancreatic fistula. Acute pancreatitis is the result of excessive alcoholic intake and gallbladder disorders such as gallstones. Chronic pancreatitis commonly results from alcoholism in adults and is associated with the trauma of the abdomen in children. The traumatic injury of the pancreas is rare because the pancreas is relatively protected by its retroperitoneal localization. An important but unusual precedent is the pitch surgery PRo malignancy or for necrotizing pancreatitis.

The diagnosis of pancreatic fistula is performed by fluid analysis inside the pleura or abdominal cavity. When the level of amylase, pancreatic enzyme, greater than 1,000 international units (IU) per liter and the level of pancreatic proteins is greater than 3.0 g/dl, the diagnosis is confirmed. Computer tomography (CT) with contrast can help locate the fistula. A useful diagnostic procedure for biliary tract disorders, called endoscopic retrograde cholangiopancreatography (ERCP), can also help diagnosis.

The treatment of the fistal fistula is demanding because pancreatic enzymes are required to digest food. The main principles include no oral food intake, overall parenteral nutrition and administration of somatostatin analogues such as octreotide to inhibit pancreatic secretion. Endoscopic treatment by ERCP and placing the stent or drain can be done to reduce pressure in the PANcreatic channel. If conservative and endoscopic treatment fails, surgical treatment can be performed by pancreatic resection or pancreatic -odenectomy.