Pure pancreaticocutaneous fistula shunted into the urinary bladder. Lesson learned by an incomplete, original attempt.
Because pancreaticocystostomy is a method of exocrine secretion management in pancreas transplantation, a legitimate question is whether a pure pancreatic fistula could be shunted into the bladder. After duodenopancreatectomy for cancer, a pancreaticojejunostomy leakage was treated by pancreas-saving anastomosis disconnection. The resulting pure pancreaticocutaneous fistula was later diverted into the bladder using a Denver valved-pump device. Technical problems necessitated redoing the shunt using a modified technique and device. Although the system did work, catheter displacement outside the bladder finally caused device takedown and external fistula restoration. Our attempt did not succeed mostly because of our inexperience in dealing with an altogether novel issue without appropriate technology. Supposing its feasibility, a pancreatic-bladder shunt might have a role in treating pure pancreatic fistulas or creating an external fistula whenever the pancreatic remnant is unreliable for an anastomosis, or when a leaked anastomosis' disconnection is preferable to completion pancreatectomy.
1 Department of Surgical Sciences, University of Parma Medical School, Parma, Italy.
Vincenzo
V
Violi
Carlo
C
Salvemini
Antonio
A
Darecchio
Paolo
P
Detullio
Renato
R
Costi
D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012086:Reoperation; D017211:Treatment Failure; D001743:Urinary Bladder / Q000601:surgery*
Anastomotic leak; Denver device; Fistula-bladder shunt; Pancreatectomy; Pancreatic fistula; Pancreatic remnant; Urinary bladder