David Fan, DO, Brian Welch, DO, Ajit Singh, Aleksandr Demin, DO, Darshak Shah, MD. Flushing Hospital Medical Center
Pancreatic stump leak and fistula formation are significant causes of morbidity in patients undergoing distal pancreatectomy (DP), with incidence of 15% to as high as 64% in a large systematic review. We present a case of a 58 year old female, four months status post distal pancreatectomy and splenectomy for pseudopapillary neoplasm of pancreatic tail. Patient presented to our institution with 7 day history of left upper quadrant pain and general malaise. Differential diagnosis on admission was abdominal wall abscess vs incarcerated incisional hernia. Physical exam was positive for severe tenderness to palpation over a ~4cm x 4cm non reducible mass in left upper quadrant with surrounding skin erythema. Patient underwent a diagnostic laparoscopy and intraoperative findings revealed extensive adhesions to the anterior abdominal wall and a loop of small bowel was found adhered to the previous incision site in left upper quadrant. Upon further dissection we entered a large 10 x 8 cm cavity with saponified caseous material. The saponified material and thick tan fluid were evacuated into an endocatch bag and two large bore jackson pratt drains were left within the cavity. Further examination showed that the small intestine was normal with no signs of obstruction or ischemia. Fluid studies and cultures were sent and showed yeast like organisms and negative for acid fast bacillus. We report an unusual presentation of a distal pancreatectomy stump leak in the formation of an intra-abdominal saponified fluid collection four months after the primary procedure. Given the high incidence of pancreatic stump leak and fistula formation after distal pancreatectomy, much effort has been made to identify factors associated with higher incidence of leaks and their usual and unusual presentations, which will be reviewed in this report.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87367
Program Number: P523
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster