INTERNAL PANCREATIC FISTULA - SURGICAL-TR EATMENT

The authors present 13 cases of internal pancreatic fistula, of which 11 were secondary to a chronic pancreatitis and two were caused by an abdominal trauma. Beside the clinical picture, the diagnosis was antic ipated by the high amylase levels present in the fluid obtained by par acentesis or thoracocentesis. The diagnosis was confirmed by the radio logical analysis of the pancreatic duct system, when an endoscopic ret rograde pancreatography was performed in seven patients, one pancreato graphy was carried out during surgery in five cases, and one patient u nderwent an injection of hydrosoluble contrast in the pleural cavity. The treatment was latero-lateral pancreaticojejunoanastomosis in five cases, associated with a corporo-caudal pancreatectomy in four patient s; a cephalic duodenopancreatectomy was performed in one case. Two pat ients underwent a cystoenteroanastomosis, while the option chosen in t he last four cases was an external drainage. One patient refused to un dergo surgical treatment. Operation mortality was null. The conclusion was that an adequate surgical treatment results in the occlusion of t he internal pancreatic fistula and, furthermore, allows for the defini tive resolution of underlying pancreatic affection.