Clinical Analysis Of18Cases With Alimentary Tract Fistula In Severe Acute Pancreatitis

Objective: To investigate the risk factors and clinical diagnosis and treatmentexperience of the alimentary tract fistulas after severe acute pancreatitis (SAP), so as toimprove cure rate of SAP and reduce its morbidity and mortality of alimentary tract fistula.Methods: A retrospective study was made on18SAP cases complicated with alimentarytract fistula to analyze its occurrence of risk factors, location, and the clinical diagnosisand treatment were summarized in this paper, from January2006to August2011.Results: Most patients occurred colonic fistulas44.4%(8/18), duodenal fistulas27.8%(5/18), gastric fistulas11.1%(2/16), duodenal fistula+colonic fistula5.6%(1/18),duodenal fistula+intestine fistula5.6%(1/18). Alimentary tract fistulas were found mostin3-9weeks of postoperative,18cases all of them peripancreatic infection, and all ofthem were diagnosed accurately by X-ray; Early surgery in2cases(＜2weeks), lateroperation in16patients(＞2weeks); Intraoperative placed the tube (8-ranging from11);17cases of intraoperative prophylactic gastrostomy and jejunostomy and early recoveryenteral nutrition. The16cases were cured, cure rate was88.9%(16/18),1case ofduodenal fistula forgo the therapy because of abdominal cavity hemorrhage and1case ofcolonic fistula died of serious systematic infection and merge multiple organ failure.Conclusion: Alimentary tract fistulas complicated by SAP is related to pancreatic juicecorrosion, infection, the operation occasion and way, drainage tube quantity, drainage tubeposition and placement time, the most important is pancreatic juice corrosion; X-ray is amethod of safty and credibility in diagnosis. The emphasis is on fully effective surgicalmethod such as choosing minimally invasive of drainage, and established early enteralnutrition support treatment and positive control of infection.