External pancreatic fistula in pancreatic injuries
Abstract
The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. 36 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in all the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily intravenous infusion for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment in 80.5 % led to the elimination of fistula. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Interruption of the MPD with diastasis between its ends or impossibility to fulfill endoscopic stenting of the pancreatic duct was an indication to surgical formation of anastomosis between distal part of the MPD and gastro-intestinal tract. Antisecretory treatment was carried out in all the cases of surgical interventions.
About the Authors
M. S. Khubutiya
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation
Russian Federation
E. V. Stepan
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation
Russian Federation
A. S. Ermolov
Research Institute of Emergency Care n.a. N. V. Sklifosovsky; Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
M. L. Rogal
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation
Russian Federation
P. A. Ivanov
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation
Russian Federation
References
1. Гришин И. Н. Кисты, свищи поджелудочной железы и их осложнения / И. Н. Гришин, В. Н. Гриц, С. Н. Лагодич.- Минск: Вышэйшая школа, 2009. - 272 с.
2. Хирургическое лечение панкреатических свищей / А. В. Шабунин, В. В. Бедин, К. Д. Далгатов [и др.] // Альманах Института хирургии имени А. В. Вишневского. - 2011.- Т. 6, № 2.- С. 34.
3. Эндоскопическое протезирование протока поджелудочной железы в лечении панкреатических свищей / С. Г. Шаповальянц, А. Г. Мыльников, С. А. Будзинский, А. В. Шабрин // Анналы хирургической гепатологии.-2012.- № 2.- С. 51-54.
4. Barnes S. M. Somatostatin analog treatment of pancreatic fistulas / S. M. Barnes, B. G. Kontny, R.A. Prinz // Int. J. Pancreatol.- 1993.- Vol. 14, N. 2.- P. 181-188.
5. Conservative treatment of postoperative pancreatic fistula. Role of interventional radiology / L. Aldrighetti, M. Castrucci, M. Catena [et al.] // Minerva Chir.- 1996.- Vol. 51, N. 10.- P. 839-848.
6. Failure of somatostatin or an analog to promote closure of end pancreatic fistulae / B. M. Miller, L. W. Traverso, P. C. Freeny, N. N. Abumrad // Int. J. Pancreatol.- 1989.- Vol. 4, N. 1.- P. 65-72.
7. Ho H. Gastrointestinal and pancreatic complications associated with severe pancreatitis / H. Ho, C. Frey // Arch. Surg.- 1995.- Vol. 130, N. 8.- P. 817-822.
8. Pancreatic fistula: definition and current problems / G. Butturini, D. Daskalaki, E. Molinari [et al.] // J. Hepatobiliary Pancreat. Surg.- 2008.- Vol. 15, N. 3.- P. 247-251.
9. Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience / C. Bassi, M. Falconi, R. Salvia [et al.] // Langenbecks Arch. Surg.- 2000.- Vol. 385, N. 1.- P. 10-13.
10. Turner J. W. The use of a somatostatin analog in the treatment of an external pancreatic fistula / J. W. Turner // Mo. Med.- 1994.- Vol. 91, N. 12.- P. 737-739.
Review
For citations:
Khubutiya M.S., Stepan E.V., Ermolov A.S., Rogal M.L., Ivanov P.A. External pancreatic fistula in pancreatic injuries. Medical alphabet. 2017;1(5):14-18. (In Russ.)
Views:
346
Email this article 