Pancreatic fistula pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The disruption of the pancreatic duct either from an iatrogenic insult, underlying inflammatory process or trauma results in the leakage of the pancreatic fluid inducing inflammation and erosions, thereby forming abnormal connections with the surrounding structures.
Pathophysiology
- The pathophysiology of pancreatic fistula involves the disruption of the pancreatic duct either from an iatrogenic insult, underlying inflammatory process or trauma.
- The disruption of the pancreatic duct causes gradual loss of the integrity of the tissue resulting in the leakage of the pancreatic fluid which induces inflammation and erosions, thereby leading to the formation of abnormal connections between the duct and the surrounding structures.[1][2]
- Pseudocyst is a complication of pancreatic fistula when fibroinflammatory rind is formed due to fluid collections and the leak which is caused by pancreatic fistula.
- Pancreatic secretions are rich in bicarbonate and protein, in some cases where the fistulas are big in size it might lead to the following conditions:
- Dehydration
- Metabolic acidosis (due to loss of bicarbonate)
- Malnutrition (due to malabsorption of fats)
- Based on the anatomical location of the pancreatic fistulas it will result in the following complications:[3][4][5][6][7]
- Anterior pancreatic fistula results in pancreatic ascites
- Posterior pancreatic fistula results in pleural effusions or mediastinitis
- Thoracopancreatic fistulas when pancreatic secretions leaks from through openings in the diaphragm
- Pancreaticobronchial fistulas
- Pancreaticomediastinal fistulas
- Pancreaticopericardial fistulas
References
- ↑ Nahm CB, Connor SJ, Samra JS, Mittal A (2018). "Postoperative pancreatic fistula: a review of traditional and emerging concepts". Clin Exp Gastroenterol. 11: 105–118. doi:10.2147/CEG.S120217. PMC 5858541. PMID 29588609.
- ↑ Hackert T, Werner J, Büchler MW (2011). "Postoperative pancreatic fistula". Surgeon. 9 (4): 211–7. doi:10.1016/j.surge.2010.10.011. PMID 21672661.
- ↑ Kaman L, Behera A, Singh R, Katariya RN (2001). "Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management". ANZ J Surg. 71 (4): 221–5. doi:10.1046/j.1440-1622.2001.02077.x. PMID 11355730.
- ↑ Kochhar R, Goenka MK, Nagi B, Singh K (1995). "Pancreatic ascites and pleural effusion treated by endoscopic pancreatic stent placement". Indian J Gastroenterol. 14 (3): 106–7. PMID 7657363.
- ↑ Neumann S, Caca K, Mössner J (2004). "[Pancreatico-pleural fistula in chronic pancreatitis with necrosis of the pancreatic tail]". Dtsch Med Wochenschr. 129 (34–35): 1802–5. doi:10.1055/s-2004-829032. PMID 15314743.
- ↑ Uchiyama T, Suzuki T, Adachi A, Hiraki S, Iizuka N (1992). "Pancreatic pleural effusion: case report and review of 113 cases in Japan". Am J Gastroenterol. 87 (3): 387–91. PMID 1539580.
- ↑ Fulcher AS, Capps GW, Turner MA (1999). "Thoracopancreatic fistula: clinical and imaging findings". J Comput Assist Tomogr. 23 (2): 181–7. doi:10.1097/00004728-199903000-00004. PMID 10096323.