title: Roux-en-Y drainage of a pancreatic fistula for disconnected pancreatic duct syndrome after acute necrotizing pancreatitis.
abstract: BACKGROUND
  After acute necrotizing pancreatitis (ANP), a pancreatic fistula may occur from disconnected pancreatic duct syndrome (DPDS) where a segment of the pancreas is no longer in continuity with the main pancreatic duct.
  
  
  OBJECTIVE
  To study the outcome of patients treated using Roux-Y pancreatic fistula tract-jejunostomy for DPDS after ANP.
  
  
  METHODS
  Between 2002 and 2011, patients treated for DPDS in the setting of endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopanreatography (MRCP) documented main pancreatic duct disruption with Roux-Y pancreatic fistula tract-jejunostomy.
  
  
  RESULTS
  In all, seven patients with DPDS were treated. The median age was 62 years (range 49-78) and five were men. The cause of ANP was gallstones (2), alcohol (1), ERCP (1) and idiopathic (3). Pancreatic necrosectomy was done in six patients. Time from onset of pancreatitis to fistula drainage was 270 days (164-365). Pancreatic fistulae arose from DPDS in the head/neck (4) and body/tail (3). Patients had a median fistula output of 140 ml (100-200) per day before surgery. The median operative time was 142 min (75-367) and estimated blood loss was 150 ml (25 to 500). Patients began an oral diet on post-operative day 4 (3-6) and were hospitalized for a median of 7 days (5-12). The median follow-up was 264 days (29-740). Subsequently, one patient required a distal pancreatectomy. After surgery, three patients required oral hypoglycaemics. No patient developed pancreatic exocrine insufficiency.
  
  
  CONCLUSIONS
  Internal surgical drainage using Roux-en-Y pancreatic fistula tract-jejunostomy is a safe and definitive treatment for patients with DPDS.
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, 84132, USA.
authors.forename: Erik G
authors.initials: EG
authors.lastname: Pearson
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Scaife
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Mulvihill
authors.forename: Robert E
authors.initials: RE
authors.lastname: Glasgow
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome