关键词: 胰腺炎, 胃肠道瘘, 外科手术, 微创性, 创伤递增式治疗

Abstract: Diagnosis and treatment of necrotizing pancreatitis complicated with gastrointestinal fistula        WANG Ge-fei, REN Jian-an. Department of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
Corresponding author：REN Jian-an, E-mail: jan@medmail.com.cn
Abstract    Gastrointestinal fistula is a common and serious complication of necrotizing pancreatitis, with high mortality. The formation of visceral venous thrombosis, direct corrosion of adjacent intestinal walls by pancreatic juice and necrotic tissue, and invasive procedures or surgeries are the causes of gastrointestinal fistulas. Multiple organ failure, severity of infection and necrosis, and surgical intervention rate are risk factors for concurrent gastrointestinal fistula, and early enteral nutrition is a protective factor. When sepsis worsens, gastrointestinal bleeding or organ function deteriorates in patients with necrotizing pancreatitis, it is necessary to suspect the occurrence of gastrointestinal fistula. CT is an important means of diagnosing NP complicated with gastrointestinal fistula, and intestinal contrast enhancement CT can improve diagnostic accuracy. Further diagnosis still depends on examinations such as gastrointestinal imaging, sinography, or endoscopy. The infection characteristics of necrotizing pancreatitis complicated with gastrointestinal fistula are the coexistence of peripancreatic necrotic tissue infection and intra-abdominal infection caused by gastrointestinal fistula. When implementing source control of infection, both should be taken into account, and the “step-up” or “step-jump” strategy can be selected according to the condition. Most upper gastrointestinal fistulas can self-heal through conservative therapy, while colon fistulas often require enterostomy to divert digestive fluid to control infection, followed by definitive surgical treatment in the later stage.

Key words: pancreatitis, gastrointestinal fistula, surgical procedures, minimally invasive, step-up approach