Pancreaticoureteral fistula following penetrating abdominal trauma

• Published in: Journal of the Pancreas Vol. 8; no. 5; pp. 613 - 616
• Main Authors: Wolf, Joshua H, Miller, George, Ashinoff, Russell, Dave, Jasmine, Lefleur, Richard S, Frangos, Spiros G, Miglietta, Maurizio A
• Format: Journal Article
• Language: English
• Published: Italy 07-09-2007
• Subjects: Abdominal Injuries - complications; Abdominal Injuries - surgery; Adolescent; Humans; Male; Nephrectomy; Pancreatic Ducts - diagnostic imaging; Pancreatic Ducts - pathology; Pancreatic Fistula - diagnostic imaging; Pancreatic Fistula - etiology; Postoperative Complications; Radiography; Ureter - diagnostic imaging; Ureter - pathology; Urinary Fistula - diagnostic imaging; Urinary Fistula - etiology; Wounds, Gunshot - complications; Wounds, Gunshot - surgery
• ISSN: 1590-8577

The main pancreatic duct can form a fistulous communication with another epithelium in the setting of prolonged inflammation, operative manipulation, or direct trauma. We present a rare complication of a pancreaticoureteral fistula following a trauma nephrectomy.
A 17-year-old male who sustained a gunshot wound to the back arrived to our Emergency Room hyopotensive, tachycardic, and with free intraperitoneal fluid on focused assessment sonography for trauma (FAST) exam. He was taken to the operating room for an exploratory laporatomy where a left nephrectomy was performed to control active bleeding from the left renal hilum. Significant bleeding was also encountered at the portal venous confluence. After packing and damage control laparotomy, the periportal/pancreatic bleeding was controlled during a second procedure 6 hours later. After one month in the Intensive Care Unit with an open abdomen, a computed tomography (CT) scan revealed a fluid collection in the splenic fossa which was drained by catheter. Persistent drainage revealed a high amylase concentration (greater than 50,000 U/L). A fistulogram revealed interruption of the main pancreatic duct, and a fluid collection by the tail of the pancreas that was in communication with the left ureter. The patient's urine amylase was also elevated. The patient was treated non-operatively given the healing open abdomen and controlled fistula. He had an otherwise uncomplicated recovery.
This is the second report of a pancreaticoureteral fistula in the literature. Treatment of this communication should be similar to that of other pancreatic fistulae.