Grade B postoperative pancreatic fistula (POPF) often presents with nonspecific symptoms — abdominal pain, fever, and an elevated inflammation index. Initial management relies on antibiotic therapy combined with nutritional support. When that line does not achieve closure of the fistula, a further therapeutic escalation is required.
Postoperative pancreatic fistula grade B presenting with abdominal pain, fever, and an increased inflammation index, requiring therapeutic intervention beyond initial conservative management.
Antibiotic therapy (with nutritional support) was initiated as the first-line approach for grade B POPF. The treatment target — closure of the pancreatic fistula — was not achieved, indicating the need for the next therapeutic step described in this protocol.
Management at this stage involves drainage of the collected pancreatic fluid, performed under imaging guidance as part of a structured step-up approach. The full protocol specifies the drainage modalities, procedural sequencing, and clinical decision points involved.
Resolution of abdominal pain and gastric outlet obstruction.
DOI: 10.1097/JS9.0000000000001395
Patients with grade B POPF can present with a variety of nonspecific symptoms including abdominal pain, fever, and increased inflammations index and requires only antibiotic therapy.
Drainage of the collected pancreatic fluid is mandatory when the patient shows clinical signs of infection not only to mitigate the associated symptoms such as abdominal pain, gastric outlet obstruction and, most importantly, to prevent postoperative hemorrhage (e.g. formation of arterial pseudo-aneurysms secondary to POPF) and septic shock that can lead to life-threatening consequences.
A step-up approach, consisting of percutaneous catheter drainage followed, only in case of failure, by surgical necrosectomy, has replaced surgical debridement as the standard treatment, reducing the risk of further morbidities and subsequent complications.
Endoscopic and percutaneous drainage appear to be equally effective and complementary interventions for POPF-associated collections.
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