Internal pancreatic fistulae with serous effusions in chronic pancreatitis.
BACKGROUND
Serous effusions in chronic pancreatitis are infrequent but persistent. These occur usually as a consequence of internal pancreatic fistulae and commonly involve the pleural cavity or peritoneum.


METHODS
To assess strategies in operative management, the records of 12 patients who underwent surgery for internal pancreatic fistula with underlying chronic pancreatitis were reviewed retrospectively. Seven patients had pancreatic ductal calculi. Three cases underwent external drainage. Three cases with leaking pseudocysts underwent cystojejunostomy-en-Y. Three cases with ductal dilatation or calculi underwent lateral pancreaticojejunostomy and three patients had caudal pancreatectomy for distal disease.


RESULTS
Eight patients were completely controlled of all symptoms, with no sequelae. One case each had recurrent pancreatitis and ascites but did not require re-operation. There were two deaths: one with massive haematemesis and one with pre-existent multi-organ failure and sepsis.


CONCLUSIONS
Pancreatic duct stones may be causally associated with internal pancreatic fistulae. Delineation of ductal anatomy and pathological aberrations of the pancreas, including determination of the leak site, was of paramount importance in planning surgery. Peroperative ductography proved the most useful in this regard.
Dhar
P
P
Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi, India.
Tomey
S
S
Jain
P
P
Azfar
M
M
Sachdev
A
A
Chaudhary
A
A
D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001201:Ascites / Q000209:etiology*; D002137:Calculi / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002423:Cause of Death; D002908:Chronic Disease; D004322:Drainage; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010185:Pancreatic Fistula / Q000209:etiology* / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D010193:Pancreaticojejunostomy; D010195:Pancreatitis / Q000150:complications* / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000209:etiology*; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018805:Sepsis