A 65-year-old man who is 5 days status post–pancreaticoduodenectomy has ongoing clear output from his surgical drain—a volume of 500 mL over 24 hours and is otherwise recovering uneventfully. Drain amylase is 8000 U/L and serum amylase is 75 U/L. The most appropriate next step in management of this pancreatic fistula is which of the following?
A. Computed tomography scan of the abdomen and pelvis
B. Observation, maintenance of the surgical drain, nothing by mouth (NPO; nil per os), and total parenteral nutrition
C. Broad-spectrum antibiotics
D. Return to the operating room for revision of the pancreaticojejunostomy
E. Observation and maintenance of the drain
Preview next quiz:
A 56-year-old woman presents 6 months after an episode of acute pancreatitis complicated by pseudocyst, which was treated with percutaneous drainage and subsequent drain removal. She now reports abdominal pain and early satiety. Computed tomography shows a 5-cm pancreatic pseudocyst near the pancreatic tail, in a similar location as her initial pseudocyst. Magnetic resonance cholangiopancreatography demonstrates a communication between the pseudocyst and pancreatic duct. What is the most appropriate initial management?
A. Repeat percutaneous drainage
B. Endoscopic pancreatic stent placement
C. Endoscopic transgastric drainage
D. Minimally invasive pseudocyst drainage and cystogastrostomy
E. Open pseudocyst drainage and pancreatojejunostomy
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