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Management of Ductal Leaks

Chapter

Abstract

Pancreatic duct leaks can occur as a result of the inflammation associated with acute pancreatitis. Leaks have a wide range of clinical manifestations, which vary based on the severity and location of the leak as well as the body’s ability to wall off or control its output. Pancreatic leaks can be internal or external. External leaks represent pancreaticocutaneous fistulas, while internal leaks can present as pseudocysts, pancreatic ascites, high amylase pleural effusions, disconnected duct syndrome (DDS), or other complications. Most minor leaks will resolve with conservative management while major leaks often require interventions. Historically, patients with pancreatic leaks have been treated surgically; however, more recently endoscopic and interventional radiology therapies have been developed. Pancreatic leak patients are now best cared for by a multidisciplinary team involving gastroenterologists, interventional radiologists, and pancreatic surgeons. Treatment of internal leaks involves both treating the leak and the consequences of the leak. Placement of a transpapillary stent that bridges the ductal disruption is likely to result in resolution of the leak as long as DDS is not present. Fluid collections such as pseudocysts can often be treated by endoscopic transmural drainage with or without endoscopic ultrasound assistance. Endoscopic therapies for pancreatic leaks have shown good efficacy with low rates of complications.

Keywords

Pancreatic Duct Fluid Collection Severe Acute Pancreatitis Pancreatic Injury Pancreatic Leak 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Digestive Disease InstituteVirginia Mason Medical CenterSeattleUSA

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