A Case of Postoperative Pancreatic Fistula after Distal Gastrectomy Cured by the Somatostatin Analogue and FXIII

Manabu Nishiwaki, Hiroshi Ashida, Hitoshi Tada, Akihiko Nishioka, Joji Utsunomiya

Second Department of Surgery, Hyogo College of Medicine

Pancreatic fistula is a severe postoperative complication, and it may be fatal. We experienced a case in which administratior of factor XIII and a somatostatin analogue (Sandostatin^®) was very effective against the pancreatic fistula after distal gastrectomy for gastric cancer. A 48-year-old man received distal gastrectomy with Billroth-Il reconstruction under a diagnosis of early gastric cancer at another hospital. Pancreatic fistula due to the intraoperative pancreatic injury developed postoperatively. The pancreatic fistula persisted with an amylase-rich effluent of 450-1800 ml/day. moreover, a duodenal fistula caused by rupture of the duodenal stump and hemorrhagic shock due to itraabdominal bleeding were secondary caused by the pancreatic fistula. He was admitted to our hospital with hemorrhagic shock. a surgical hemostatic procedure was performed, in which an injured portion of the pancreas was not detected. Postoperatively, combined therapy with intravenous administration of factor XIII (6 V/day) and subcutaneous administration of Sandostatin^® (200 µg/day) was attempted. Fistula outputs was markedly reduced. The pancreatic fistula closed on the 21st day, and the duodenal fistula closed on the 26th day after administration of Sandstatin^® was started. Combined therapy with factor XIII and somatostatin analogue is a reasonable and effective therapeutic method.

Key words
somatostatine analogue, pancreatic fistula, duodenal suture insufficiency

Reprint requests
Manabu Nishiwaki Second Department of Surgery, Hyogo College of Medicine
1-1, Mukogawa-cho, Nishinomiya, 663 JAPAN

Accepted
December 6, 1995

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