Acute pancreatitis after pancreatectomy: Inside the dilemma pancreatitis-pancreatic fistula

The interesting paper by Ikenaga et al about acute pancreatitis after pancreatic resections merits some patho-physiological observations. 1 N. Ohtsuka T. Nakata K. Watanabe Y. Mori Nakamura M. Clinical significance of postoperative pancreatoduodenectomy and distal pancreatectomy. Surgery. 2020; 169: 732-737 Abstract Full Text PDF PubMed Scopus (9) Google Scholar Besides pathogenic elements in common with other abdominal operations, we identify as a specific factor the stasis juice, leading to subsequent pancreatitis. In case pancreatectomy, independently from techniques stump sealing, this induces an area surrounding section rim, possibly evolving into diffuse or Wirsung duct fistula. Similarly, pancreatoduodenectomy, malfunctioning anastomosis duct, always through same mechanism juice stasis, can cause secondary pancreatitis, often followed more dangerous leakage mixed gastric jejunal content, depending on technique employed. 2 Manenti A. Farinetti Simonini E. Calderoni S. pancreatitis: its morphoclinical relevance. J Am Coll Surg. 2015; 220: 254 (1) ,3 Lee P.J. Papachristou G.I. New insights Nat Rev Gastroenterol Hepatol. 2019; 16: 479-496 Crossref (84) On basis current knowledge, observed cases limited around penetrating injuries traumatic contusions body, histologic documents proving focal neoplastic obstruction typically intraductal neoplasms, developed concept “acute localized pancreatitis.” 4 Saluja Dudeja V. Dawra R. Sah R.P. Early intra-acinar events pathogenesis Gastroenterology. 156: 1979-1993 (45) Clearly, disease worsen early stage form, mainly when adverse factors, failed anastomosis, are not removed. This agrees pancreas anatomy, where segmental subdivision based sure landmarks vascular ductal excretory networks cannot be drawn. 5 Zhu C. Jia Z. Zhang X. Yu Q. Qin Anatomical segmentectomy head along embryological fusion plane: series literature review. Medicine (Baltimore). 2018; 97e0623 ,6 Renard de Mestier L. Perez Avisse Lévy P. Kianmanesh Unraveling segmentation. World 42: 1147-1153 (4) recalling “focal” disease, suspected laboratory signs but precisely diagnosed computed tomography magnetic resonance cholangiopancreatography that demonstrate key signs: intraparenchymal necrosis dilation/obstruction main branches. 7 Khurana Nelson L.W. Myers C.B. al. Reporting radiologists-time for systematic change structured reporting template. Abdom Radiol (NY). 45: 1277-1289 radiological tools preoperatively useful detecting inherent risk factors anatomic variations anatomy pre-existing lesions such pancreatoliths. At surgery, all invites careful tailoring according eventually spatulating narrowed outlet, privilege temporary external/internal stenting. 8 Andrianello Marchegiani G. Malleo Pancreaticojejunostomy externalized stent vs pancreaticogastrostomy patients high-risk anastomosis: single-center, phase 3, randomized clinical trial. JAMA 155: 313-321 (22) , 9 Pavesi Zizzo Improving treatment pancreaticoduodenectomy. 2016; 222: 324 (2) 10 Sato H. Ishida Motoi F. Combination longitudinal pancreaticojejunostomy coring-out (Frey procedure) pancreatectomy chronic Surg Today. 49: 137-142 (3) pancreatectomySurgeryVol. 169Issue 4PreviewThe definition complication surgery was proposed 2016. Its presence relevance have been established, especially Full-Text