GASTROINTESTINAL AND PANCREATIC COMPLICATIONS ASSOCIATED WITH SEVERE PANCREATITIS

Objective: To study the outcomes of gastrointestinal fistulas and panc reatic ductal disruption in severe pancreatitis. Setting: University t ertiary referral center. Patients: One hundred thirty-six patients fro m 1982 to 1994. Intervention: Diversion followed by resection and osto my closure for gastrointestinal fistulas, pancreaticojejunostomy for p ancreatic fistulas, and excision, external drainage,or internal draina ge for pseudocysts. Results: The incidence of infection was 24% (8/33) for peripancreatic fluid collections and 59% (61/103) for patients wi th necrosis plus fluid collections or necrosis without fluid. Sixty-ni ne patients developed 25 gastrointestinal fistulas and 51 complication s caused by pancreatic ductal disruption. Necrosis and infection but n ot the open packing technique were associated with increased risk of g astrointestinal fistulas. In patients with pancreatic ductal disruptio n, pancreatic fistulas developed following necrosectomy and external d rainage, while pancreatic pseudocysts evolved from undrained peripancr eatic fluid collections. Gastrointestinal fistulas required prompt ope rative intervention, whereas pancreatic ductal disruption was treated nonoperatively initially. The mortality rate was 13% (3/23) in patient s with gastrointestinal fistulas, similar to the overall mortality rat e of 10.3% (14/136). There was no mortality in patients with pancreati c fistulas or pseudocysts. Length of hospital stay was prolonged by th e presence of necrosis and infection, not by gastrointestinal fistulas or ductal disruption. Thirty-eight of the 69 patients with these comp lications required readmission for operative management of their compl ications. To date, only 18 (13.2%) of 136 patients with severe pancrea titis have not required surgical intervention. Conclusions: Gastrointe stinal fistulas and pancreatic ductal disruption are common in severe pancreatitis. Although these complications are not associated with inc reased mortality or prolonged initial length of stay, readmission for elective surgical correction is necessary in most patients. Severe pan creatitis is a surgical disease, requiring both acute and long-term su rgical care.