[Pathogenesis and clinic of pancreatic fistulas (author's transl)].

At the Surgical University Clinik of Mainz 53 patients with a pancreatic fistula have been observed in 12 years (1964-1975). Most frequently these fistulas occurred after operations for acute pancreatitis (20%), after exstirpation of insulinomas (20%) or after trauma (19%). In 44 cases an external and in 9 cases an internal fistula was seen. Pathogenetic differentiation in tryptic and non-tryptic fistulas allows some prognostic conclusions. So tryptic fistulas are often complicated by internal fistulas with preference for the colon and must be operated more often. In 15 patients the persisting pancreatic fistula has been treated operatively. In seven cases pancreatic resection and in 4 cases the resection of a part of the colon was necessary. Conservatively treated fistulas in most cases closed within 6 weeks.