Dados do Trabalho

Título

Development of Pancreatoenteral Fistulas in Walled-off Necrosis

Descrição sucinta do(s) objetivo(s)

Acute pancreatitis (AP) is increasing in incidence, with 15%-20% of cases exhibiting pancreatic or peripancreatic necrosis, leading to a 30%-40% mortality rate. Walled-off Necrosis (WON) emerges in the delayed phase of necrotizing pancreatitis, often necessitating management due to complications. Non-surgical approaches, including drainage techniques, are preferred in treating WON.
Gastrointestinal fistulas (GIFs) are rare complications of acute pancreatitis, forming abnormal connections between the pancreas and the digestive tract. They can lead to severe consequences like hemorrhages and nutritional deficiencies.
Managing pancreatic fistulas in patients with WON involves techniques such as stent placement, image-guided percutaneous drainage, surgery, or a combination. The study's objective was to determine the frequency of digestive tract fistulas in WON cases using fistulography during percutaneous drainage.

Material(is) e método(s)

A retrospective analysis of 19 patients diagnosed with acute necrotizing pancreatitis, undergoing percutaneous drainage between 2018 and 2022.

Resultados e discussão

The study showed 40.9% (n=9) developed GIFs in WON, with 5 cases involving the colon, 3 the duodenum, and 1 the stomach. The mean size of walled-off necrosis was 9.5±2.4 cm, and fistulization occurred on average 65.1±17.8 days after the onset of AP. Colonic fistulas often required surgery (66.7%), but none resulted in bleeding or intestinal obstruction.
The study reported no mortalities, with most patients responding well to percutaneous drainage, avoiding surgery. The overall average hospitalization period for necrotizing pancreatitis patients was 98 days. However, those with GIFs had a longer stay (108.7 days), while those without a fistula had a shorter stay (44.4 days). Patients with GIFs experienced an average hospitalization period 10.92% longer than the overall average, while those without a fistula had a stay 54.29% shorter.

Conclusões

The study identified a 12.4% incidence of WON fistulization into the digestive tract, leading to prolonged hospitalization without increasing mortality. It is recommended to conduct future prospective studies to standardize the use of fistulography in percutaneous drainage, aiming for early diagnosis of gastrointestinal fistulas in WON.

Palavras Chave

Walled-off necrosis; Gastrointestinal fistula

Arquivos