Conservative management of pancreatic fistulae after a graft pancreatitis

UVA P; ALVARENGA E; RAINONE PE; NORESE M; CUEVAS S; CANDIA C; URDAY N; GONZALEZ R

Praga

Congreso; 13th World Congress of IPITA; 2011

The Transplantation Society - TTS

Objective: To present a case of conservative management of pancreatic fistulae following graft pancreatitis after a SKP transplant. Methods: Retrospective chart review.Results: A 40 y/o male underwent a SPK transplant from a 28 y/o donor. Pancreas ischemia time was 440 minutes. IS consisted on Thymoglubulin, FK, MMF and steroids. Graft developed immediate pancreatitis and patient received octreotide treatment sq for 1 week and remained asymptomatic. A few days later needed exploratory laparotomy for intraabdominal collection of pancreatic fluid and peripancreatic fat necrosis requiring drainage, wash out and multiple drains placement. Patient developed a pancreatic fistulae of 300cc daily. Received treatment with IM octreotide 20mg (Sandostatin LAR) monthly and antibiotics. Fistula output soon became below 100cc daily and then decreased slowly. Fistulogram confirmed a well directed fistula with no spillage of fluid within the abdominal cavity. Follow up was performed by weekly CT scan initially and then monthly. No fever or clinical symptoms occurred during treatment. After 3.5 months the fistula output stopped. CT scan confirmed resolution of fistula with no collections. Patient never received insulin of required dialysis and is now over 1 year after transplant with both grafts functioning.Conclusions: Graft pancreatitis is a much feared condition that can become life threatening. Pancreatic or peripancreatic necrosis with pancreatic fistulae often times requires graft pancreatectomy. Conservative management of this condition with antibiotics and IM octreotide can be performed with an excellent outcome provided that no clinical symptoms or fever develop. Very close follow up is required both clinically and imaging.