The Complication Of Severe Acute Pancreatitis:Gastrointestinal Fistula

Severe acute pancreatitis(SAP)is a devastating disease that is characterized with high mortality due to the development of Local or systemic complications,such as infected pancreatic and extra-pancreatic necrosis(IPN),multisystem organ failure.Gastrointestinal fistula(GIF)is a well-recognized complication secondary to SAP and has been attracting much attention.But complete duodenal occlusion(CDO)is an extremely rare complication secondary to GIF in patients with SAP.In this paper we describe a case of missed spontaneous duodenal fistula resulting in CDO in patients with SAP.ObjectivesGastrointestinal fistula(GIF)in severe acute pancreatitis(SAP)is considered as a sparse episode and studied sporadically in the literature.There is paucity of data on the prediction of the effect on risk of GIF in patient with SAP.This study was aimed to investigate risk factors related to GIF in the development of SAP.MethodsThe clinical data of 344 patients with SAP from 2010 to 2016 were reviewed retrospectively.All patients were divided into the GIF group and the non-GIF group,and their data analyzed with respect to 15 indices were applied to explore potential risk factors for GIF in patients with SAP.ResultsOf the 344 eligible patients,52(15.12%)progressed to GIF.Only occurrence of infected pancreatic and extra-pancreatic necrosis(IPN)(P=0.004,OR=3.012)and modified CT severity index(MCTSI)(P=0.033,OR=1.183)were proved to be independent risk factors for GIF in patients with SAP,and blood type B(P=0.048,OR=2.096,95%CI:0.748-3.562)indicated weaker association of risk factor for GIF.The early(48-72 h after admission)enteral nutrition(EEN)(P=0.016,OR=0.267)acted as a protective factor.ConclusionsOccurrence of IPN and high MCTSI are independent risk factors for the development of GIF in patients with SAP,blood type B reveals a potential correlation with GIF in patients with SAP.EEN is helpful to prevent the progression of GIF secondary to SAP.