An Audit of Management of Chronic Pancreatitis with Pancreatic Ductal Disruption Resulting in Ascites and Pleural Effusion
Introduction: Pancreatic Ductal Disruption (PDD) may remain a localised collection to form pseudocyst or dissect into adjacent organs or rupture freely into the peritoneal cavity or pleural cavity resulting in massive or high-volume ascites or pleural effusions. The management of pseudocyst is w...
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
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| Acceso en línea: | https://doaj.org/article/80ddc2a1622c4cd5b70e6a790d5f2492 |
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| Sumario: | Introduction: Pancreatic Ductal Disruption (PDD) may remain a
localised collection to form pseudocyst or dissect into adjacent
organs or rupture freely into the peritoneal cavity or pleural cavity
resulting in massive or high-volume ascites or pleural effusions.
The management of pseudocyst is well known among general
and gastrosurgeons, but ascites and plural effusion remain
difficult decisions. Depending on the availability of resources
total parenteral nutrition, octreotide, pancreatic duct stenting
are used with varying success. There are no guidelines as to
which intervention is preferable in different clinical scenarios.
Aim: To audit the clinical characters and management of patients
with pancreatic ascites and pleural effusion.
Materials and Methods: This study was done at the Department
of Surgical Gastroenterology, Karnataka Institute of Medical
Sciences, Hubballi, Karnataka, India. Fifty two patients with
pancreatic ascites or pancreatico pleural fistula in the background
of chronic pancreatitis satisfying both inclusion and exclusion
criteria were identified and studied from the prospectively
maintained database of patients with chronic pancreatitis in the
period from September 2010 to September 2020. The patients
were classified as conservatively managed, endoscopic main
pancreatic duct stenting or surgery. Statistical analysis was done
using windows excel. The results were expressed as percentage,
mean and Standard Deviation (SD).
Results: Five patients with ascites and two patients with pleural
effusion responded completely to conservative measures (13.4%).
In one of them ascites recurred at two months and one had left
pleural effusion recurrence at one month. Fifteen patients died
while on conservative management (68.2% mortality). Among
eight patients undergoing endoscopic pancreatic duct stenting,
ascites/pleural effusion resolved in six (75% success rate) and
remained asymptomatic during mean follow-up of 12 months.
Two patients who were not improving after stenting were lost to
follow-up. Twenty-two patients underwent surgery namely lateral
pancreatojejunostomy with resolution of symptoms. Two patients
undergoing surgery died in postoperative period due to sepsis
and chest infection (9.1% mortality). At a mean follow-up of
14 months they remained symptom free.
Conclusion: Conservative management alone has high mortality.
Early aggressive management can aim to stop leak either by
pancreatic duct stenting or surgical lateral pancreatojejunostomy
will help reduce mortality and morbidity. |
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