Pancreatic fistula pathophysiology: Difference between revisions
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==Overview== | ==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. | The disruption of the [[pancreatic duct]] either from an [[iatrogenic]] insult, underlying [[Inflammation|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== | ==Pathophysiology== | ||
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*The [[pathophysiology]] of [[pancreatic]] [[fistula]] involves the disruption of the [[pancreatic duct]] either from an [[iatrogenic]] insult, underlying [[inflammatory process]] or [[trauma]]. | *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.<ref name="pmid29588609">{{cite journal| author=Nahm CB, Connor SJ, Samra JS, Mittal A| title=Postoperative pancreatic fistula: a review of traditional and emerging concepts. | journal=Clin Exp Gastroenterol | year= 2018 | volume= 11 | issue= | pages= 105-118 | pmid=29588609 | doi=10.2147/CEG.S120217 | pmc=5858541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29588609 }} </ref><ref name="pmid21672661">{{cite journal| author=Hackert T, Werner J, Büchler MW| title=Postoperative pancreatic fistula. | journal=Surgeon | year= 2011 | volume= 9 | issue= 4 | pages= 211-7 | pmid=21672661 | doi=10.1016/j.surge.2010.10.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21672661 }} </ref> | *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.<ref name="pmid29588609">{{cite journal| author=Nahm CB, Connor SJ, Samra JS, Mittal A| title=Postoperative pancreatic fistula: a review of traditional and emerging concepts. | journal=Clin Exp Gastroenterol | year= 2018 | volume= 11 | issue= | pages= 105-118 | pmid=29588609 | doi=10.2147/CEG.S120217 | pmc=5858541 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29588609 }} </ref><ref name="pmid21672661">{{cite journal| author=Hackert T, Werner J, Büchler MW| title=Postoperative pancreatic fistula. | journal=Surgeon | year= 2011 | volume= 9 | issue= 4 | pages= 211-7 | pmid=21672661 | doi=10.1016/j.surge.2010.10.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21672661 }} </ref> | ||
*Pseudocyst is a complication of pancreatic fistula when fibroinflammatory rind is formed due to fluid collections and the leak which | *[[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: | *Pancreatic secretions are rich in [[bicarbonate]] and [[protein]], in some cases where the [[Fistula|fistulas]] are big in size it might lead to the following conditions: | ||
**Dehydration | **[[Dehydration]] | ||
**Metabolic acidosis ( | **[[Metabolic acidosis]] (due to loss of [[bicarbonate]]) | ||
**Malnutrition ( | **[[Malnutrition]] (due to [[malabsorption]] of fats) | ||
*Based on the anatomical location of the pancreatic fistulas it will result in the following complications:<ref name="pmid11355730">{{cite journal| author=Kaman L, Behera A, Singh R, Katariya RN| title=Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. | journal=ANZ J Surg | year= 2001 | volume= 71 | issue= 4 | pages= 221-5 | pmid=11355730 | doi=10.1046/j.1440-1622.2001.02077.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11355730 }}</ref><ref name="pmid7657363">{{cite journal| author=Kochhar R, Goenka MK, Nagi B, Singh K| title=Pancreatic ascites and pleural effusion treated by endoscopic pancreatic stent placement. | journal=Indian J Gastroenterol | year= 1995 | volume= 14 | issue= 3 | pages= 106-7 | pmid=7657363 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7657363 }}</ref><ref name="pmid15314743">{{cite journal| author=Neumann S, Caca K, Mössner J| title=[Pancreatico-pleural fistula in chronic pancreatitis with necrosis of the pancreatic tail]. | journal=Dtsch Med Wochenschr | year= 2004 | volume= 129 | issue= 34-35 | pages= 1802-5 | pmid=15314743 | doi=10.1055/s-2004-829032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15314743 }}</ref><ref name="pmid1539580">{{cite journal| author=Uchiyama T, Suzuki T, Adachi A, Hiraki S, Iizuka N| title=Pancreatic pleural effusion: case report and review of 113 cases in Japan. | journal=Am J Gastroenterol | year= 1992 | volume= 87 | issue= 3 | pages= 387-91 | pmid=1539580 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1539580 }}</ref> | *Based on the anatomical location of the [[Pancreatic fistula|pancreatic fistulas]] it will result in the following [[complications]]:<ref name="pmid11355730">{{cite journal| author=Kaman L, Behera A, Singh R, Katariya RN| title=Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. | journal=ANZ J Surg | year= 2001 | volume= 71 | issue= 4 | pages= 221-5 | pmid=11355730 | doi=10.1046/j.1440-1622.2001.02077.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11355730 }}</ref><ref name="pmid7657363">{{cite journal| author=Kochhar R, Goenka MK, Nagi B, Singh K| title=Pancreatic ascites and pleural effusion treated by endoscopic pancreatic stent placement. | journal=Indian J Gastroenterol | year= 1995 | volume= 14 | issue= 3 | pages= 106-7 | pmid=7657363 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7657363 }}</ref><ref name="pmid15314743">{{cite journal| author=Neumann S, Caca K, Mössner J| title=[Pancreatico-pleural fistula in chronic pancreatitis with necrosis of the pancreatic tail]. | journal=Dtsch Med Wochenschr | year= 2004 | volume= 129 | issue= 34-35 | pages= 1802-5 | pmid=15314743 | doi=10.1055/s-2004-829032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15314743 }}</ref><ref name="pmid1539580">{{cite journal| author=Uchiyama T, Suzuki T, Adachi A, Hiraki S, Iizuka N| title=Pancreatic pleural effusion: case report and review of 113 cases in Japan. | journal=Am J Gastroenterol | year= 1992 | volume= 87 | issue= 3 | pages= 387-91 | pmid=1539580 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1539580 }}</ref><ref name="pmid10096323">{{cite journal| author=Fulcher AS, Capps GW, Turner MA| title=Thoracopancreatic fistula: clinical and imaging findings. | journal=J Comput Assist Tomogr | year= 1999 | volume= 23 | issue= 2 | pages= 181-7 | pmid=10096323 | doi=10.1097/00004728-199903000-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10096323 }}</ref> | ||
**Anterior pancreatic fistula results in pancreatic ascites | **[[Anterior]] [[pancreatic fistula]] results in pancreatic [[ascites]] | ||
**Posterior pancreatic fistula results in pleural effusions or mediastinitis | **[[Posterior]] [[pancreatic fistula]] results in [[Pleural effusion|pleural effusions]] or [[mediastinitis]] | ||
**Thoracopancreatic fistulas when pancreatic secretions leaks from through openings in the diaphragm | |||
**Pancreaticobronchial fistulas | |||
**Pancreaticomediastinal fistulas | |||
**Pancreaticopericardial fistulas | |||
==References== | ==References== | ||
Latest revision as of 12:34, 10 April 2021
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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.