Subsequent monitoring of the drain site for persistent drainage is required and development of a pancreatic-cutaneous fistula is a recognized complication of this procedure. Initially these patients should be treated conservatively. If the drainage remains significant, many such patients with isolated major pancreatic duct injuries require reoperation. Persistent drainage should prompt further studies to show whether there is discontinuity of laceration of the pancreatic duct. The duct remains open, and a proximal stricture will probably prevent the fistula from closing.
Distal pancreatectomy is inappropriate because of the proximal location of the injury.
Continued observation and antibiotic therapy are not warranted at this point, and gastrojejunostomy would fail to deal with the pathologic anatomy. Although low-dose radiation therapy may abolish exocrine function, it would produce pancreatic insufficiency and would not be the treatment of choice. Surgery of the Pancreas. Invasive treatment of pancreatic fluid collections with surgical and nonsurgical methods.