A 44-year-old man has a pancreatic fistula that has persisted for 30 days following necrosectomy. The output is 60 mL/day, and there is skin excoriation at the drain exit site. He has been receiving total parenteral nutrition. White blood cell count and C-reactive protein are normal. What should be your treatment plan?
A. Administer somatostatin analogue.
B. Reassure the patient and begin oral intake.
C. Back out the existing drain over 5-7 days.
D. Perform a distal pancreatectomy.
E. Perform endoscopic retrograde cholangiopancreatography (ERCP) with stent placement.
Preview next quiz:
A 70-year-old man with chronic obstructive pulmonary disease on home oxygen, congestive heart failure, and multiple prior complex abdominal operations presents to the general surgery clinic having experienced recurrent, severe acute pancreatitis episodes in the setting of known pancreas divisum. His gastroenterologist has performed a complete workup, and there are no other inciting factors. What treatment option would you offer this patient?
A. Serial imaging every 6 months
B. Observation alone
C. Endoscopic minor papilla sphincterotomy
D. Open surgical minor papilla sphincteroplasty
E. Total pancreatectomy and denervation