Aranha et al reported a strategy for managing a patient with a pancreatic fistula following a pancreaticoduodenectomy. The authors are from Loyola University in Maywood, Illinois, and Hines VA Hospital.
Patrient selection: pancreatic fistula following pancreaticoduodenectomy, having started an oral diet. The oral feeding acts to stimulate the pancreas.
Parameters:
(1) ratio of amylase concentration in drain fluid to that in serum
(2) volume of fluid from drain in mL per day
amylase ratio =
= (amylase concentration in drain fluid) / (amylase concentration in serum)
where:
• In the diagram a ratio referenced to serum amylase was used. In the text the upper limit of the normal reference range for amylase (125 IU/L) is used.
Amylase Ratio
Volume in mL/day
Plan
< 3
< 50 mL/day
remove drain and discharge patient
< 3
>= 50 mL/day
discharge patient with drain, remove at clinic visit
>= 3
< 50 mL/day
discharge patient with drain, remove at clinic visit
> 3
>= 50 mL/day
perform drain study and start TPN
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