Acute necrotising pancreatitis is a systemic disorder associated with multiple, serious complications occurring outside of the pancreas, both locally and distally. Improved survival depends on early and precise diagnosis, modern intensive-care management, and adequate drainage techniques. However the presence of infection can adversely affect outcome and lead to systemic sepsis and multiorgan failure. There are a number of general measures for facilitating recovery, but surgical debridement is the only possible curative course of action. Pancreatic and gastrointestinal fistulae are primary complications of acute necrotising pancreatitis, occurring in 9-46% of patients, and mostly a condition that is so severe it requires surgical intervention. The pathogenesis of these fistulae is multifactorial and includes autodigestion and inflammation, thrombosis ischaemic and iatrogenic trauma. Gastrointestinal fistulae (reported in up to 27% of patients), occur as a consequence of the local complications of pancreatitis, and in the case of the colon reflect a more severe necrotising state with almost a doubling in mortality rate. External pancreatic fistulae may occur spontaneously, but are much more often the result of surgical (drainage placement or debridement) or radiologically guided drainage operations (9-15% incidence). The overall aim of management is to provide conditions in which the fistula might be expected to close spontaneously, comprising general resuscitation, adequate drainage and skin protection, but most importantly, detection and elimination of sepsis. The treatment of fistulae should be specific, based upon a series of biochemical, physical and anatomical criteria. The identification of an end or side fistula is critical in determining the course of action. Surgery is the only real option for end fistulae but the treatment of side fistulae may involve endoscopic, conservative and pharmacological intervention, such as Somatostatin-14. With all the impinging variables in necrotising pancreatitis fistula development, and current therapeutic interventions available, it is important that the clinician formulates and undertakes a logical approach to treatment. Further, this management should be tailored to be most beneficial to the individual patient, and at the same time as cost-effective as possible.
|Number of pages||13|
|Journal||Research and Clinical Forums|
|Publication status||Published - 2002|
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