INCIDENCE AND MANAGEMENT OF PANCREATIC AND ENTERIC FISTULAS AFTER SURGICAL-MANAGEMENT OF SEVERE NECROTIZING PANCREATITIS

Objective: To determine the incidence, type, and outcome of complicati ons of necrotizing pancreatitis. Setting: Major tertiary referral cent er (Mayo Clinic, Rochester, Minn). Patients: Sixty-one patients seen f rom 1985 to 1994 who underwent surgical management of severe necrotizi ng pancreatitis and who developed pancreatic or gastrointestinal fistu las. Main Outcome Measures: Incidence, management, and outcome of panc reatic and gastrointestinal fistulas. Results: Twenty-five patients (4 1%) developed pancreatic (14 patients) and/or gastrointestinal tract c utaneous (19 patients) fistulas. While three duodenal fistulas and one colonic fistula were recognized at the initial operation for pancreat ic necrosectomy, the remainder developed 4 to 60 days after the initia l operation. Spontaneous closure occurred in nine of 14 pancreatic, tw o of two gastric, two of four enteric, two of eight colonic, and four of five duodenal fistulas. Mortality of the group with fistulas was 24 % (6/25) and was not different from the mortality of the patients with necrotizing pancreatitis without fistulas (28% [10/36]). Conclusions: Pancreatic and gastrointestinal tract fistulas are common complicatio ns of surgical treatment of severe necrotizing pancreatitis. Well-cont rolled gastric, pancreatic, and enteric fistulas have the greatest lik elihood of spontaneous closure. Duodenal and colonic fistulas may need surgical intervention for control or repair. Mortality in these patie nts parallels the mortality for severe necrotizing pancreatitis.