Pancreatic fistula: Difference between revisions
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==[[Pancreatic fistula classification|Classification]]== | ==[[Pancreatic fistula classification|Classification]]== | ||
Pancreatic fistula can be classified anatomically as; | |||
Internal fistula: The pancreatic duct communicates with internal organs or body cavity such as pleural or peritoneal cavity. | |||
External fistula: The pancreatic duct communicates with the skin, otherwise known as pancreaticocutaneous fistula. <ref name="pmid18053844">{{cite journal| author=Morgan KA, Adams DB| title=Management of internal and external pancreatic fistulas. | journal=Surg Clin North Am | year= 2007 | volume= 87 | issue= 6 | pages= 1503-13, x | pmid=18053844 | doi=10.1016/j.suc.2007.08.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18053844 }} </ref> | |||
Pancreatic fistula can also be classified based on the anatomy of the pancreatic duct and the location of injury as; | |||
Type 1 pancreatic fistula: Involves injury to the pancreatic parenchyma with leakage from the distal part of the pancreatic duct or the side branches. | |||
Type 2 pancreatic fistula: Involves injury to and leak from the main pancreatic duct. | |||
Type 3 pancreatic fistula: Occurs as a result of proximal or distal pancreatectomy. <ref name="pmid28780610">{{cite journal| author=Mutignani M, Dokas S, Tringali A, Forti E, Pugliese F, Cintolo M | display-authors=etal| title=Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification. | journal=Dig Dis Sci | year= 2017 | volume= 62 | issue= 10 | pages= 2648-2657 | pmid=28780610 | doi=10.1007/s10620-017-4697-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28780610 }} </ref> | |||
Pancreatic fistula is classified into two categories on the basis of clinical manifestations, complications and severity by the ISGPF as; | |||
Biochemical pancreatic fistula: This category includes fistula with no significant clinical symptoms. | |||
Clinically relevant pancreatic fistula: This category includes fistulas under grade B and C, which shows significant clinical symptoms and require surgical interventions, re-surgeries and can complicate into organ failure and death.<ref name="pmid31840199">{{cite journal| author=Jiang L, Ning D, Chen X| title=Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions. | journal=Front Med | year= 2020 | volume= 14 | issue= 3 | pages= 251-261 | pmid=31840199 | doi=10.1007/s11684-019-0727-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31840199 }} </ref> | |||
==[[Pancreatic fistula pathophysiology|Pathophysiology]]== | ==[[Pancreatic fistula pathophysiology|Pathophysiology]]== | ||
Revision as of 10:27, 17 March 2021
| Pancreatic fistula | |
| MeSH | D010185 |
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Pancreatic fistula Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pancreatic fistula On the Web |
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American Roentgen Ray Society Images of Pancreatic fistula |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A pancreatic fistula is an abnormal connection between the epithelialized surfaces of the pancreatic duct and adjacent or distant structures, organs or cavities. Clinical criteria defined by the International Study Group for Pancreatic Fistula (ISGPF) is a measurable drain output containing pancreas-derived enzyme amylase which is greater than three times the upper limit of the normal serum level measured on or after postoperative day three. A revised grading for pancreatic fistula was proposed by ISGPF, according to which pancreatic fistula is graded either into a new category which involve an asymptomatic leakage from the pancreas called biochemical leak (BL), or Grade B including patients who undergo surgical procedures such as percutaneous or endoscopic drainage or angiographic procedures in order to promote the healing of fistula and Grade C including patients with organ failure requiring reoperations and mortality as a result of complication from pancreatic fistula.
Historical Perspective
Classification
Pancreatic fistula can be classified anatomically as; Internal fistula: The pancreatic duct communicates with internal organs or body cavity such as pleural or peritoneal cavity. External fistula: The pancreatic duct communicates with the skin, otherwise known as pancreaticocutaneous fistula. [1] Pancreatic fistula can also be classified based on the anatomy of the pancreatic duct and the location of injury as; Type 1 pancreatic fistula: Involves injury to the pancreatic parenchyma with leakage from the distal part of the pancreatic duct or the side branches. Type 2 pancreatic fistula: Involves injury to and leak from the main pancreatic duct. Type 3 pancreatic fistula: Occurs as a result of proximal or distal pancreatectomy. [2] Pancreatic fistula is classified into two categories on the basis of clinical manifestations, complications and severity by the ISGPF as; Biochemical pancreatic fistula: This category includes fistula with no significant clinical symptoms. Clinically relevant pancreatic fistula: This category includes fistulas under grade B and C, which shows significant clinical symptoms and require surgical interventions, re-surgeries and can complicate into organ failure and death.[3]
Pathophysiology
Causes
Differentiating Pancreatic fistula from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | ERCP | Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
- ↑ Morgan KA, Adams DB (2007). "Management of internal and external pancreatic fistulas". Surg Clin North Am. 87 (6): 1503–13, x. doi:10.1016/j.suc.2007.08.008. PMID 18053844.
- ↑ Mutignani M, Dokas S, Tringali A, Forti E, Pugliese F, Cintolo M; et al. (2017). "Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification". Dig Dis Sci. 62 (10): 2648–2657. doi:10.1007/s10620-017-4697-5. PMID 28780610.
- ↑ Jiang L, Ning D, Chen X (2020). "Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions". Front Med. 14 (3): 251–261. doi:10.1007/s11684-019-0727-3. PMID 31840199.