Pancreatic Fistula Occurring After Colon Cancer Resection?
Pancreatic Fistula Occurring After Colon Cancer Resection?
What is the recommended management for a pancreatic fistula occurring after resection of colon cancer at the splenic flexure?
Pancreatic fistulas occur most commonly after pancreatic surgery, especially distal pancreatectomy. A pancreatic fistula complicating resection of a colon cancer suggests either laceration of the pancreas with main duct injury, or a blunt insult. Pancreatic cancers sometimes encase the transverse colon during local metastasis, but colon cancers rarely invade the pancreas. Obviously, because of the local anatomy, removal of a splenic flexure cancer could result in injury to the nearby pancreatic tail or spleen. The management of a pancreatic fistula is percutaneous drainage (unless the fistula is to the skin), with bowel rest and total parenteral nutrition (TPN) being reserved for high-output fistulas, prolonged ileus, and smoldering pancreatitis. The great majority of pancreatic fistulas following surgery can be managed by drainage alone. Most of the remainder respond to bowel rest and TPN. Occasionally, a pancreatic fistula persists despite these interventions. A number of strategies have been employed to seal off the leaking pancreatic duct. These include transection of the pancreatic parenchyma using a stapling device, direct suture of the duct/fistula, use of the Harmonic Scalpel (Ethicon Endo-Surgery, Inc.; Cincinnati, Ohio) for dissection, or application of fibrin glue or cyanoacrylate, etc. Suppression of pancreatic exocrine secretion by the synthetic somatostatin analog, octreotide, has been helpful in a few cases, but the results are unpredictable and often disappointing. The average time to closure of a "simple" postoperative pancreatic fistula is 3-5 weeks.
What is the recommended management for a pancreatic fistula occurring after resection of colon cancer at the splenic flexure?
Pancreatic fistulas occur most commonly after pancreatic surgery, especially distal pancreatectomy. A pancreatic fistula complicating resection of a colon cancer suggests either laceration of the pancreas with main duct injury, or a blunt insult. Pancreatic cancers sometimes encase the transverse colon during local metastasis, but colon cancers rarely invade the pancreas. Obviously, because of the local anatomy, removal of a splenic flexure cancer could result in injury to the nearby pancreatic tail or spleen. The management of a pancreatic fistula is percutaneous drainage (unless the fistula is to the skin), with bowel rest and total parenteral nutrition (TPN) being reserved for high-output fistulas, prolonged ileus, and smoldering pancreatitis. The great majority of pancreatic fistulas following surgery can be managed by drainage alone. Most of the remainder respond to bowel rest and TPN. Occasionally, a pancreatic fistula persists despite these interventions. A number of strategies have been employed to seal off the leaking pancreatic duct. These include transection of the pancreatic parenchyma using a stapling device, direct suture of the duct/fistula, use of the Harmonic Scalpel (Ethicon Endo-Surgery, Inc.; Cincinnati, Ohio) for dissection, or application of fibrin glue or cyanoacrylate, etc. Suppression of pancreatic exocrine secretion by the synthetic somatostatin analog, octreotide, has been helpful in a few cases, but the results are unpredictable and often disappointing. The average time to closure of a "simple" postoperative pancreatic fistula is 3-5 weeks.
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