Pancreatic fistula
Introduction
Introduction to pancreatic fistula Common in pancreatic surgery, pancreatic trauma, contended pancreatitis, pancreatic biopsy occurs, pancreatic juice extravasation accumulates in the abdominal cavity, trypsin is activated and digested. The pancreatic-cavity organ is formed adjacent to the organ, and the blood vessel can also be corroded to cause hemorrhagic shock. The large loss of pancreatic juice often leads to imbalance of water and electrolyte, which is one of the serious complications of pancreatic surgery. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: hemorrhagic shock dehydration
Cause
Pancreatic fistula
The disease is mainly caused by the self-digestion of pancreatic tissue by pancreatic tissue. Under normal circumstances, the trypsinogen in pancreatic juice is inactive, and when it flows into the duodenum, it is activated by enterokinase in bile and intestinal fluid to become active trypsin, which has digested protein. The role. During pancreatic fistula, trypsin is activated by certain factors (described below), which in turn activate other enzymatic reactions, such as elastase and phospholipase A, which induce self-digestion of the pancreas and promote its Necrosis is dissolved. It has been found that the zymogen granules of the pancreatic acinus contain a high concentration of elastase, which contains an inactive precursor of the enzyme in the pancreatic secretion, which can be activated by trypsin to dissolve the elastic tissue and thereby destroy the blood vessel. Wall and pancreatic ducts.
Prevention
Pancreatic fistula prevention
Careful and accurate anastomosis techniques, proper management of the main pancreatic duct and placement of effective drainage are the main measures to prevent pancreatic fistula. Prevent pancreatic trauma and prevent complications from pancreatic surgery.
Complication
Pancreatic fistula complications Complications, hemorrhagic shock, dehydration
Corrosive blood vessels can cause hemorrhagic shock. A large loss of pancreatic juice often leads to dehydration and electrolyte imbalance.
Symptom
Pancreatic fistula symptoms Common symptoms Abdominal discomfort, bowel, abdominal distension, abdominal pain, upper abdominal pain, high fever
Symptom
Pancreatic surgery, trauma and persistent abdominal pain after acute pancreatitis, bloating, fever, weakened bowel sounds, clearing liquid at the incision or drainage.
2. Signs
Incision, severe pain in the drainage, skin erosion, high fever when drainage is poor, inflammatory mass in the upper abdomen, antibiotic treatment is invalid.
Examine
Examination of pancreatic fistula
1. Laboratory inspection:
(1) Trypsin assay: Serum amylase assay is the most widely used diagnostic method. The increase of serum amylase can be measured within 24 hours after onset, serum amylase value increased significantly >500U / dl (normal value 40 ~ 180U / dl, Somogyi method), and gradually decreased to normal within 7 days. Urine amylase assay is also a sensitive indicator for the diagnosis of this disease. Uro-amylase is elevated slightly later but lasts longer than serum amylase. Urinary amylase is significantly elevated (normal value 80-300 U / dl, Somogyi method) has diagnostic significance. The higher the amylase measurement, the higher the diagnostic accuracy. However, the level of amylase is not necessarily proportional to the severity of the lesion. A significant increase in serum lipase (normal value 23-300 U / L) is a more objective indicator for the diagnosis of acute pancreatic fistula. The thickening of serum amylase isoenzymes improves the correctness of the diagnosis of this disease. The diagnosis of acute pancreatic fistula can be excluded when serum amylase is elevated but P-isozyme is not high.
(2) Other items: including increased white blood cells, hyperglycemia, abnormal liver function, low blood calcium, blood gas analysis and abnormal DIC indicators. Diagnostic punctures are occasionally used for diagnosis. The puncture fluid is bloody turbid. Elevated amylase and lipase are diagnostic and are not ideal diagnostic methods due to their aggressiveness and possible complications.
2. Radiographic diagnosis:
(1) Chest X-ray: the left lower lobe is inferior, the left semitendinosus is elevated, and the left pleural effusion reflects inflammation around the diaphragm and retroperitoneum. Support for the diagnosis of acute pancreatic fistula but lack specificity. It is an auxiliary diagnostic indicator.
(2) Abdominal plain film: It can be seen that the duodenum is inflated, indicating that the proximal jejunum is dilated. It can also be seen that the colonic dysfunction sign indicates that the transverse colon is dilated, and there is no gas shadow in the spleen colon and the distal colon. Or visible gallstone shadows and pancreatic duct stones, and the disappearance of the waist muscles. It is an auxiliary diagnostic method for acute pancreatic fistula.
(3) Abdominal B-ultrasound: can help diagnose. B-ultrasound can detect the accumulation of pancreatic edema and peripancreatic fluid. Can also detect gallstones, bile duct stones. However, it is limited by the coverage of the partially inflated intestinal fistula.
Diagnosis
Diagnosis and differentiation of pancreatic fistula
Mainly differentiated from pancreatic cancer, pancreatitis and other acute abdomen.
