Pancreatic Fistula – Types, Causes, Symptoms, Diagnosis and Treatment

The pancreas are an important organ of the digestive system. It is actually a gland which performs both endocrine and exocrine functions. It endocrine functions include producing important hormones like insulin, glucagon and somatostatin. Its exocrine functions would include excreting digestive enzymes which helps in breaking down the food.

Pancreatic fistula

(PF) is a condition in which an abnormal passage way is formed between the pancreas and other organs. This happens when a damage or injury to the ducts of the pancreas causes leakage of the the secretions from the said organ.

Types of Pancreatic Fistula

The said condition manifests itself in two ways:

  • Internal PF

    : PF is said to be internal when they connect with internal organs or spaces.

  • External PF

    : PF is said to be external when the abnormal connection opens to the skin through the abdominal wall.

Causes of the condition

  • Diseases of the pancreas as in chronic pancreatitis.
  • Formation of a leaking pancreatic pseudocyst. A pseudocyst is a sac filled with fluids such as pancreatic enzymes, tissues of the pancreas and blood.
  • Alcohol induced pancreatitis.
  • Trauma or injury to the pancreatic ducts during abdominal surgery.
  • Pancreatic biopsy.
  • Blunt pancreatic trauma or injury.
  • As a reaction to the catherter placed to drain away excess pancreatic secretions. The erosion of the catherter tip can cause it.
  • Drainage of pancreatic cysts and abscess is also known to cause External fistula.

Symptoms of the condition

  • Constant secretion of bicarbonate rich fluids from the fistula formed in the pancreas can bring about metabolic acidosis.
  • Acidosis is a condition when the body starts over producing acids. The blood pH takes a dip (less than 7.35) due to production of excess hydrogen in the body.
  • Significant weight loss is noticed.
  • The patient not responding to diuretics can also be an indication of the disease.
  • Pancreatic ascites can be caused. It involves the accumulation of the secretions in the free peritoneal cavity. It is the space between the membraneous lining of the abdominal organs and the abdominal wall.
  • It can also cause pancreatic pleural effusion where the fluids get accumulated in the cavity surrounding the lungs.

Diagnosis of the condition

  • A specimen of the accumulated fluid is sent for analysis. Amylase level over 1000 IU/L and protein levels over 3.0 g/dL is indicative of the condition.
  • An elevated level of serum amylase is also found in this situation.
  • CT Scan and Endoscopic Retrograde Cholanglopancreatography (ERCP) is done to diagnose the condition. ERCP is especially important as it effectively combines the the procedure of endoscopy and fluoroscopy to detect the condition.

Treatment of Pancreatic Fistula

  • The over secretion of the pancreatic enzymes is brought down by reducing the amount of food intake.
  • The nutrition of the patient is maintained by intravenous feeding where the normal procedures of eating and digestion can be avoided.
  • Somatostatin hormonal replacements are also administered parallely.
  • Surgery may be needed to fix the leak.
  • Fistulectomy or removal of the fistula along with the associated part of the pancreas is also essential in some cases.

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