Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair
Pancreatic fistulas are a known complication following gastrointestinal surgeries, especially when there is disruption to pancreatic tissue or ducts. These fistulas occur due to leakage of pancreatic enzymes, which can lead to inflammation, infection, and other complications. While typically associa...
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Elsevier
2025-09-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043325004364 |
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| author | Richard Adams, DO Mena Louis, DO Nathaniel Grabill, MD Jasmine Lake, BS Timothy Stevens, MD Nelson Royall, MD |
| author_facet | Richard Adams, DO Mena Louis, DO Nathaniel Grabill, MD Jasmine Lake, BS Timothy Stevens, MD Nelson Royall, MD |
| author_sort | Richard Adams, DO |
| collection | DOAJ |
| description | Pancreatic fistulas are a known complication following gastrointestinal surgeries, especially when there is disruption to pancreatic tissue or ducts. These fistulas occur due to leakage of pancreatic enzymes, which can lead to inflammation, infection, and other complications. While typically associated with pancreatic resections, fistulas can develop when the ulcer involves the pancreas leading to pancreatic ductal disruption. A 59-year-old female presented with hyperacute epigastric pain, hematemesis, septic shock with a blood pressure of 89/62, a Boey score of 3, and a Pulp score of 4. Imaging revealed a perforated duodenal ulcer with signs of peritonitis and based off the WSES guidelines for the management of Perforated Bleeding Ulcers published in 2020, she underwent exploratory laparotomy with ulcer repair. Postoperatively, she developed a pancreaticocutaneous fistula, confirmed by elevated amylase in the wound drainage. She was managed conservatively with percutaneous drainage and the placement of a pancreatic stent, leading to gradual resolution of the fistula. Management of pancreatic fistulas focuses on early diagnosis and intervention to prevent complications such as abscess formation or sepsis. Endoscopic stenting helps relieve pressure on the pancreatic duct and promotes fistula closure. Nutritional support, including pancreatic enzyme replacement therapy, may be necessary for patients with impaired pancreatic function to aid in digestion and reduce pancreatic strain. Most pancreatic fistulas can be managed conservatively without surgery if identified early, combining drainage, endoscopic stent and sphincterotomy, and nutritional support. Early intervention improves outcomes and reduces the risk of additional complications. |
| format | Article |
| id | doaj-art-ab6124c9d9f643378abc31b9cf7b2f26 |
| institution | DOAJ |
| issn | 1930-0433 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
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| series | Radiology Case Reports |
| spelling | doaj-art-ab6124c9d9f643378abc31b9cf7b2f262025-08-20T03:17:03ZengElsevierRadiology Case Reports1930-04332025-09-012094184418810.1016/j.radcr.2025.05.003Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repairRichard Adams, DO0Mena Louis, DO1Nathaniel Grabill, MD2Jasmine Lake, BS3Timothy Stevens, MD4Nelson Royall, MD5Department of Graduate Medical Education, General Surgery Residency Program, Northeast Georgia Medical Center, 743 Spring Street NE Gainesville, GA 30501, Gainesville, GA, USA; Corresponding author.Department of Graduate Medical Education, General Surgery Residency Program, Northeast Georgia Medical Center, 743 Spring Street NE Gainesville, GA 30501, Gainesville, GA, USADepartment of Graduate Medical Education, General Surgery Residency Program, Northeast Georgia Medical Center, 743 Spring Street NE Gainesville, GA 30501, Gainesville, GA, USACollege of Medicine, August University and University of Georgia Medical Partnership, 981 Wisteria View Court, Dacula GA 30019, Athens, GeorgiaDepartment of Surgery, Trauma & Acute Care Surgery, Northeast Georgia Medical Center, 743 Spring Street NE Gainesville, GA 30501, Gainesville, GA, USADepartment of Surgery, Hepato-Pancreato-Biliary Surgery, Northeast Georgia Medical Center, 743 Spring Street NE Gainesville, GA 30501, Gainesville, GA, USAPancreatic fistulas are a known complication following gastrointestinal surgeries, especially when there is disruption to pancreatic tissue or ducts. These fistulas occur due to leakage of pancreatic enzymes, which can lead to inflammation, infection, and other complications. While typically associated with pancreatic resections, fistulas can develop when the ulcer involves the pancreas leading to pancreatic ductal disruption. A 59-year-old female presented with hyperacute epigastric pain, hematemesis, septic shock with a blood pressure of 89/62, a Boey score of 3, and a Pulp score of 4. Imaging revealed a perforated duodenal ulcer with signs of peritonitis and based off the WSES guidelines for the management of Perforated Bleeding Ulcers published in 2020, she underwent exploratory laparotomy with ulcer repair. Postoperatively, she developed a pancreaticocutaneous fistula, confirmed by elevated amylase in the wound drainage. She was managed conservatively with percutaneous drainage and the placement of a pancreatic stent, leading to gradual resolution of the fistula. Management of pancreatic fistulas focuses on early diagnosis and intervention to prevent complications such as abscess formation or sepsis. Endoscopic stenting helps relieve pressure on the pancreatic duct and promotes fistula closure. Nutritional support, including pancreatic enzyme replacement therapy, may be necessary for patients with impaired pancreatic function to aid in digestion and reduce pancreatic strain. Most pancreatic fistulas can be managed conservatively without surgery if identified early, combining drainage, endoscopic stent and sphincterotomy, and nutritional support. Early intervention improves outcomes and reduces the risk of additional complications.http://www.sciencedirect.com/science/article/pii/S1930043325004364Pancreatic fistulaDuodenal ulcerPeritonitisEndoscopic retrogradeCholangiopancreatographyExocrine pancreatic insufficiency |
| spellingShingle | Richard Adams, DO Mena Louis, DO Nathaniel Grabill, MD Jasmine Lake, BS Timothy Stevens, MD Nelson Royall, MD Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair Radiology Case Reports Pancreatic fistula Duodenal ulcer Peritonitis Endoscopic retrograde Cholangiopancreatography Exocrine pancreatic insufficiency |
| title | Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair |
| title_full | Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair |
| title_fullStr | Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair |
| title_full_unstemmed | Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair |
| title_short | Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair |
| title_sort | pancreatico cutaneous fistula following complicated perforated peptic duodenal ulcer repair |
| topic | Pancreatic fistula Duodenal ulcer Peritonitis Endoscopic retrograde Cholangiopancreatography Exocrine pancreatic insufficiency |
| url | http://www.sciencedirect.com/science/article/pii/S1930043325004364 |
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