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(Radiology. 1999;213:573-578.)
© RSNA, 1999

Vascular and Interventional Radiology

Persistent Pancreatocutaneous Fistula after Percutaneous Drainage of Pancreatic Fluid Collections: Role of Cause and Severity of Pancreatitis1

Mehran Fotoohi, MD, Horacio B. D'Agostino, MD 2, Bruce Wollman, MD, Kenneth Chon, MD, Seyed Shahrokni, BA and Eric vanSonnenberg, MD

1 From the Department of Radiology (C5-XR), Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA 98101 (M.F.); the Department of Radiology, University of California Medical Center, San Diego (H.B.D., B.W., S.S.); and the Department of Radiology, University of Texas Medical Branch at Galveston (K.C., E.v.S.). From the 1996 RSNA scientific assembly. Received August 14, 1998; revision requested October 15; revision received January 12, 1999; accepted April 30. Address reprint requests to M.F. (e-mail: radm1f@ix.netcom.com).

PURPOSE: To assess the relationship between the cause and severity of pancreatitis and the development of persistent pancreatocutaneous fistula (PPCF) after percutaneous drainage of pancreatic fluid collections.

MATERIALS AND METHODS: Sixty patients (44 male, 16 female; age range, 10–74 years) were included in the study. The cause of pancreatitis was postoperative in 29 patients, alcoholism in 20 patients, biliary in six patients, hyperlipidemia in two patients, unknown in two patients, and trauma in one patient. Patients requiring intensive care unit treatment for their condition at the time of drainage were considered to have severe pancreatitis. Thirty-seven patients had mild pancreatitis, and 23 had severe pancreatitis. PPCF was defined as catheter drainage of pancreatic fluid of more than 10 mL/d for more than 4 weeks after catheter placement.

RESULTS: PPCF developed in 27 of the 60 patients. It occurred in five of the six patients with biliary pancreatitis, 10 of the 20 with alcohol-related pancreatitis, and 10 of the 29 with postoperative pancreatitis (P > .2). The prevalence of PPCF was higher in patients with severe pancreatitis (n = 16 [70%]) than in those with mild pancreatitis (n = 11 [30%]). This difference was statistically significant (P < .002).

CONCLUSION: Development of PPCF correlated with severity of pancreatitis, regardless of the cause of pancreatitis.

Index terms: Fistula, gastrointestinal tract, 77.289 • Pancreas, CT, 77.12111, 77.12112, 77.12115 • Pancreas, interventional procedures, 77.1263 • Pancreatitis, 77.291