Adams Richard, Louis Mena, Grabill Nathaniel, Lake Jasmine, Stevens Timothy, Royall Nelson
Department of Graduate Medical Education, General Surgery Residency Program, Northeast Georgia Medical Center, 743 Spring Street NE Gainesville, GA 30501, Gainesville, GA, USA.
College of Medicine, August University and University of Georgia Medical Partnership, 981 Wisteria View Court, Dacula GA 30019, Athens, Georgia.
Radiol Case Rep. 2025 Jun 4;20(9):4184-4188. doi: 10.1016/j.radcr.2025.05.003. eCollection 2025 Sep.
Pancreatic fistulas are a known complication following gastrointestinal surgeries, especially when there is disruption to pancreatic tissue or ducts. These fistulas occur due to leakage of pancreatic enzymes, which can lead to inflammation, infection, and other complications. While typically associated with pancreatic resections, fistulas can develop when the ulcer involves the pancreas leading to pancreatic ductal disruption. A 59-year-old female presented with hyperacute epigastric pain, hematemesis, septic shock with a blood pressure of 89/62, a Boey score of 3, and a Pulp score of 4. Imaging revealed a perforated duodenal ulcer with signs of peritonitis and based off the WSES guidelines for the management of Perforated Bleeding Ulcers published in 2020, she underwent exploratory laparotomy with ulcer repair. Postoperatively, she developed a pancreaticocutaneous fistula, confirmed by elevated amylase in the wound drainage. She was managed conservatively with percutaneous drainage and the placement of a pancreatic stent, leading to gradual resolution of the fistula. Management of pancreatic fistulas focuses on early diagnosis and intervention to prevent complications such as abscess formation or sepsis. Endoscopic stenting helps relieve pressure on the pancreatic duct and promotes fistula closure. Nutritional support, including pancreatic enzyme replacement therapy, may be necessary for patients with impaired pancreatic function to aid in digestion and reduce pancreatic strain. Most pancreatic fistulas can be managed conservatively without surgery if identified early, combining drainage, endoscopic stent and sphincterotomy, and nutritional support. Early intervention improves outcomes and reduces the risk of additional complications.
胰瘘是胃肠道手术后已知的并发症，尤其是在胰腺组织或导管受到破坏时。这些瘘是由于胰酶泄漏而发生的，这可能导致炎症、感染和其他并发症。虽然通常与胰腺切除术有关，但当溃疡累及胰腺导致胰管破裂时也可能发生瘘。一名59岁女性出现超急性上腹痛、呕血、感染性休克，血压为89/62，Boey评分为3，Pulp评分为4。影像学检查显示十二指肠溃疡穿孔并有腹膜炎体征，根据2020年发布的WSES关于穿孔性出血性溃疡管理的指南，她接受了剖腹探查术并进行溃疡修复。术后，她出现了胰皮瘘，伤口引流液中淀粉酶升高证实了这一点。她接受了经皮引流和放置胰腺支架的保守治疗，瘘逐渐消退。胰瘘的管理重点在于早期诊断和干预，以预防脓肿形成或败血症等并发症。内镜支架置入有助于减轻胰管压力并促进瘘闭合。对于胰腺功能受损的患者，可能需要营养支持，包括胰腺酶替代疗法，以帮助消化并减轻胰腺负担。如果早期发现，大多数胰瘘可以通过保守治疗而无需手术，联合引流、内镜支架置入和括约肌切开术以及营养支持。早期干预可改善预后并降低额外并发症的风险。
