Patients with expanding peripancreatic fluid on abdominal imaging or with persistent symptoms undergo endoscopic therapy via endoscopic retrograde cholangiopancreatography (ERCP) as it is a preferred approach towards the management of a symptomatic pancreatic fistula due to its diagnostic as well as therapeutic value. A transpapillary pancreatic stent is placed during ERCP and/or a pancreatic sphincterectomy is done. If no improvement is seen or endoscopic therapy is not feasible, the patient may receive surgical treatment. Surgical treatment depends upon the location of the fistula where the duct is disrupted, the size of the peripancreatic fluid collection, presence of vascular thrombosis, tissue necrosis and history of previous interventions. Surgical treatment may involve the drainage of pancreatic pseudocyst if indicated, which is often associated with chronic pancreatic fistula. Other options may include fistulojejunostomy, pancreatic resection and decompression of the pancreatic duct with pancreatojejunostomy.
Pancreatic fistula surgery
Pancreatic pseudocyst surgery
Pancreatic fistula medical therapy
Gastrointestinal perforation surgery
Acute pancreatitis surgery
Secondary peritonitis surgery
Annular pancreas surgery
Ileus surgery