Pancreatic fistula pathophysiology

The disruption of the pancreatic duct either from an iatrogenic insult, underlying inflammatory process or trauma results in the leakage of the pancreatic fluid inducing inflammation and erosions, thereby forming abnormal connections with the surrounding structures.

• The pathophysiology of pancreatic fistula involves the disruption of the pancreatic duct either from an iatrogenic insult, underlying inflammatory process or trauma.
• The disruption of the pancreatic duct causes gradual loss of the integrity of the tissue resulting in the leakage of the pancreatic fluid which induces inflammation and erosions, thereby leading to the formation of abnormal connections between the duct and the surrounding structures.^[1][2]
• Pseudocyst is a complication of pancreatic fistula when fibroinflammatory rind is formed due to fluid collections and the leak which is caused by pancreatic fistula.
• Pancreatic secretions are rich in bicarbonate and protein, in some cases where the fistulas are big in size it might lead to the following conditions:
  • Dehydration
  • Metabolic acidosis (due to loss of bicarbonate)
  • Malnutrition (due to malabsorption of fats)
• Based on the anatomical location of the pancreatic fistulas it will result in the following complications:^{[3][4][5][6][7]}
  • Anterior pancreatic fistula results in pancreatic ascites
  • Posterior pancreatic fistula results in pleural effusions or mediastinitis
  • Thoracopancreatic fistulas when pancreatic secretions leaks from through openings in the diaphragm
  • Pancreaticobronchial fistulas
  • Pancreaticomediastinal fistulas
  • Pancreaticopericardial fistulas

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