[A surgical etiology of respiratory distress in necrotizing pancreatitis: pancreato-bronchial fistula. 3 cases].
Adult respiratory distress syndrome (ARDS) is a frequent feature in acute pancreatitis, but précise etiology of hypoxemia remains unclear. Determinations of lipase and amylase levels are made in samples of bronchial secretion, in three intubated patients receiving assisted ventilation for severe hypoxemia occurring in the course of pancreatitis. This determination appeared to be valuable to incriminate the responsibility of a pancratico-bronchial fistula. In the first case, emergency laparotomy was able to show the fistulous track. In the second described case, an endoscopic retrograde pancreatography was performed, showing a fistula from pancreatic body to left bronchial tree. In the third case, the presence of a bronchial fistula was proved by a fistulography trough the abdominal pancreatic necrosis. A decrease of arterial PO2 followed pancreatography and fistulography. The surgical treatment was splenopancreatectomy, necrosectomy associated with left pulmonary lobectomy, and necrosectomy with colonic diversion. In the third case, pancreatico-bronchial fistula was the final evolution of an infected intra-abdominal necrosis, despite multiple surgical drainages. In the first and second cases, surgical treatment obtained a prompt and uneventful recovery. Few published cases of pancreatico-bronchial fistulae are reported. A retrospective study of 12 ARDS was made among 40 patients underwenting laparotomy, with an objective recognition of necrotizing pancreatitis, from 1980 to 1987. A pancreatico-bronchial fistula could be incriminated in three cases of these 12 ARDS. Such a prevalence of 25% has to be reevaluated after serial determinations of lipase and amylase levels in bronchial samples of intubated patients suffering from ARDS in the course of pancreatic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Fekete
F
F
Le Mee
J
J
Langonnet
F
F
Gayet
B
B
Belghiti
J
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010185:Pancreatic Fistula / Q000209:etiology* / Q000601:surgery; D010195:Pancreatitis / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012189:Retrospective Studies
Une étiologie chirurgicale de la détresse respiratoire au cours de la pancréatite nécrosante: la fistule pancréatico-bronchique. Trois observations.