DISTAL PANCREATECTOMY FOR UNRESOLVING INTERNAL PANCREATIC FISTULA- A CASE REPORT

Dr. Chandrasekar Murugesan; Prof.Sankar Subramanian; Dr. Santhosh Kumar Ganapathi; Dr. Neelendra Yesaswy

Volume : IX, Issue : VIII, August - 2020

DISTAL PANCREATECTOMY FOR UNRESOLVING INTERNAL PANCREATIC FISTULA- A CASE REPORT

Dr. Chandrasekar Murugesan, Prof. Sankar Subramanian, Dr. Santhosh Kumar Ganapathi, Dr. Neelendra Yesaswy

Abstract :

Pancreatic–pleural fistula and pancreatic ascites are uncommon but recognised sequelae of pancreatitis leading to the disruption of the pancreatic duct. The management depends on the clinical history with underlying aetiology, site, and extent of the pancreatic duct leak. Management options are conservative medical therapy, endotherapy, and surgery. We report a middle age chronic alcoholic patient who had presented with abdominal distension and weight loss. He had a history of acute alcoholic pancreatitis and had underwent open cystogastrostomy for pancreatic pleural fistula with pseudocyst. On examination, the abdomen was grossly distended with free fluids with no tenderness. The ascitic fluid analysis showed markedly elevated amylase and raised albumin. CT abdomen showed gross ascites with fluid extending into the posterior mediastinum and collection in the distal body of pancreas with suspicion of disconnected pancreatic duct syndrome The patient was diagnosed with unresolving internal pancreatic fistula and managed successfully with distal pancreatectomy. Further we have discussed the clinical presentation, investigation and management of internal pancreatic fistula.