Table 1 Clinical, procedural and outcome details of pancreatic duct fistulas managed percutaneously
Patient | Diagnosis | Type of surgery | Presentation | Percutaneous procedures | Catheter drainage duration (days) | Outcome |
|---|---|---|---|---|---|---|
1 | Pancreatic neuroendocrine neoplasm | Partial resection/enucleation | Duct fistula at resection/enucleation site, DPDS (tail) | Percutaneous drain, percutaneous necrosectomy, disconnected duct catheterization through cavity, duct occlusion with n-BCA and coils | 114 | PFC resolved. Disconnected pancreas defunctionalized. Fistula closed |
2 | Pancreatic ductal adenocarcinoma | Pancreatico-duodenectomy | Anastomotic fistula | Surgical drain exchange, trans-peritoneal jejunostomy and duct catheterization for external diversion of secretions | 65 | PFC resolved. Fistula palliated with direct diversion of pancreatic secretions until death from liver metastases |
3 | Pancreatic ductal adenocarcinoma | Distal pancreatectomy and splenectomy | Stump fistula | Percutaneous drain, duct catheterization through cavity, and duct occlusion with n-BCA and coils | 77 | PFC resolved. Stump fistula closed |
4 | Pancreatic ductal adenocarcinoma | Pancreatico-duodenectomy | Anastomotic fistula | Surgical drain exchange, trans-peritoneal jejunostomy, and duct catheterization for complete external diversion of secretions | 131 | PFC resolved. Anastomosis healed and fistula closed |
5 | Chronic pancreatitis | Pancreatico-duodenectomy | Anastomotic fistula | Percutaneous drain, trans-hepatic jejunostomy, and duct catheterization for complete external diversion of secretions | 66 | PFC resolved. Anastomosis healed and fistula closed |
6 | Pancreatic ductal adenocarcinoma | Distal pancreatectomy and splenectomy | Stump fistula | Percutaneous drain, duct catheterization through cavity, and duct occlusion with coils | 28 | PFC resolved. Stump fistula closed |
7 | Renal cell carcinoma metastasis | Partial resection/enucleation | Duct fistula at resection/enucleation site, DPDS (tail) | Percutaneous drain, duct catheterization through cavity for complete external diversion of secretions | 68 | PFC resolved. Temporizing therapy until elective surgical pancreatico-jejunostomy |
8 | Acute necrotizing pancreatitis | WON, DPDS (body and tail) | Percutaneous drain, percutaneous necrosectomy, duct catheterization through cavity for complete diversion of secretions, and placement of internal pancreatic stent | 168 | PFC resolved. Disconnected duct continuity re-established with internal pancreatic duct stent. Ductal disruption healed | |
9 | Acute necrotizing pancreatitis | WON, DPDS (tail) | Percutaneous drain, percutaneous necrosectomy, and duct catheterization through cavity for complete external diversion of secretions | 154 | PFC resolved. Temporizing therapy until elective surgical pancreatico-jejunostomy | |
10 | Acute necrotizing pancreatitis | WON | Percutaneous drain, percutaneous necrosectomy, and duct catheterization through cavity for complete external diversion of secretions | 181 | PFC resolved. Ductal disruption healed | |
11 | Acute necrotizing pancreatitis | DPDS (tail) | Percutaneous drain, percutaneous necrosectomy, failed duct catheterization through cavity | 363 | PFC resolved with prolonged drainage only. Ductal disruption healed |