Postoperative Pancreatic Fistula after a Left Cytoreductive Nephrectomy

JOURNAL TITLE: Journal of Medical Academics

Author
1. Aditya A Jha
2. Bharath N Kumar
3. Irshad A Khan
4. Sanjeev Tandon
ISSN
DOI
10.5005/jp-journals-10070-0026
Volume
2
Issue
1
Publishing Year
2019
Pages
2
Author Affiliations
1. com.mps.common.model.Contributor@1422cdc6 ,
2. com.mps.common.model.Contributor@2f27b42e ,
3. com.mps.common.model.Contributor@16844116 ,
4. com.mps.common.model.Contributor@31c2d01b
Article keywords
Case report, Left cytoreductive nephrectomy, Metastatic renal cell carcinoma, Postoperative pancreatic fistula

Abstract

Aim: The aim of the study was to report a case of postoperative pancreatic fistula (POPF) in the setting of a left cytoreductive nephrectomy. Background: Pancreatic injury during nephrectomy is a rare complication with a reported incidence of 2.1% in laparoscopic left radical nephrectomy. It has not been described in the setting of cytoreductive nephrectomy (CN) and we report one such case. Case description: A 61-years-old male underwent left CN for metastatic left renal mass. On the 5th postoperative day, there was spontaneous expulsion of the retroperitoneal drain, two days after which the patient developed a serous discharge of 25–30 mL per day from the drain site, which later became purulent. The patient was managed successfully with pigtail drainage of the collection, culture-sensitive antibiotics, and subcutaneous injection of octreotide. Conclusion: Conservative management of POPF after nephrectomy in the form of drainage of retroperitoneal collection, antibiotics, somatostatin analogs, and discontinuing oral diet with total parenteral nutrition (TPN) (as indicated) is successful in most cases. Clinical significance: A pancreatic injury during a left CN is a distinct possibility, which can be managed successfully by conservative means.

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