From the Guidelines
After a distal pancreatectomy and stent placement to drain a pancreatic pseudocyst, patients are at risk for complications such as infection, stent migration, pseudocyst recurrence, abscess or intra-abdominal sepsis, pancreatic fistula, and post-traumatic pancreatitis. The most common complication is pseudocyst recurrence, which can be evaluated using CT-scan or MRI, and guided percutaneous drainage can be performed using US or endoscopic US (EUS) to avoid radiation exposure 1. Some key complications and their management include:
- Infection: monitored through symptoms such as fever, increased pain, and redness at incision sites
- Stent migration: identified by sudden pain or nausea
- Pseudocyst recurrence: evaluated through follow-up imaging with CT or MRI, typically scheduled 4-6 weeks post-procedure
- Abscess or intra-abdominal sepsis: diagnosed using CT-scan or MRI, with an incidence of 7-25% in patients with pancreatic injuries 1
- Pancreatic fistula: occurs in 10-35% of major pancreatic injuries, diagnosed using preoperative cross-sectional imaging and pancreatogram during ERCP, and treated using ERCP when feasible 1
- Post-traumatic pancreatitis: diagnosed using contrast-enhanced CT-scan, with an incidence of 17% in patients with abdominal pain and hyperamylasemia 1. The use of EUS in the work-up of patients with pancreatobiliary pathology may limit exposure to risk of adverse events from ERCP, and combined EUS-ERCP procedures can be effective in treating pseudocysts and abscesses 1. Follow-up care should include monitoring for these complications, as well as maintaining a low-fat diet and using oral pancreatic enzyme supplements to aid digestion, and pain management using acetaminophen and tramadol as needed.
From the Research
Complications of Distal Pancreatectomy and Stent Placement
The complications following a distal pancreatectomy and stent placement to drain a pancreatic pseudocyst can be significant. Some of the possible complications include:
- Pancreatic fistula (PF), which is the main complication of distal pancreatectomy, occurring in 10-20% of cases 2
- Delayed gastric emptying (DGE), which can occur in 20% of cases, often associated with other abdominal complications 2
- Bleeding, which can be life-threatening, especially if it occurs late after surgery 2
- Infection, such as peritonitis, which can occur as a secondary complication of PF 2
- Pseudo-aneurysm, which is a rare but potentially life-threatening complication 2
Stent-Related Complications
Stent placement can also be associated with complications, including:
- Stent occlusion or migration, which can lead to recurrence of the pseudocyst 3
- Pancreatic duct damage, which can occur during stent placement or removal 4
- Infection or abscess formation, which can occur around the stent site 5
Management of Complications
The management of these complications often requires a multidisciplinary approach, involving surgery, endoscopy, and radiology. Conservative management, including total parenteral nutrition, peripancreatic drainage, and somatostatin analogues, can be effective in resolving PF and other complications in many cases 2, 6. However, surgical intervention may be necessary in some cases, especially if complications are severe or life-threatening 3, 2.