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

Objective: To determine the incidence, type, and outcome of complications of necrotizing pancreatitis. Setting: Major tertiary referral center (Mayo Clinic, Rochester, Minn). Patients: Sixty-one patients seen from 1985 to 1994 who underwent surgical management of severe necrotizing pancreatitis and who developed pancreatic or gastrointestinal fistulas. Main Outcome Measures: Incidence, management, and outcome of pancreatic and gastrointestinal fistulas. Results: Twenty-five patients (41%) developed pancreatic (14 patients) and/or gastrointestinal tract cutaneous (19 patients) fistulas. While three duodenal fistulas and one colonic fistula were recognized at the initial operation for pancreatic necrosectomy, the remainder developed 4 to 60 days after the initial operation. Spontaneous closure occurred in nine of 14 pancreatic, two 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 complications of surgical treatment of severe necrotizing pancreatitis. Well-controlled gastric, pancreatic, and enteric fistulas have the greatest likelihood of spontaneous closure. Duodenal and colonic fistulas may need surgical intervention for control or repair. Mortality in these patients parallels the mortality for severe necrotizing pancreatitis.