Rare surgical complications of chronic pancreatitis

Background: The development of internal fistulas, the obstruction of the upper gastrointestinal tract and bile ducts, pseudoaneurisms and symptomatic pseudocysts are considered rare complications of chronic pancreatitis. The aim of the study was to review the 8-year experience in the treatment of this category of patients. Method(s): Retrospective analysis of the treatment results of patients with chronic pancreatitis who were treated in our institution during the period between January 2008 and June 2015. Result(s): Out of 135 patients, 40 were females (29.6%) and 95 - males (70.4%). Alcohol was an etiologic factor in 50 cases (37.0%). Of all patients, 52 (38.5%) suffered gastroduodenal/biliary obstruction; internal pancreatic fistulae developed in 36 (26.7%). Pseudoaneurisms of the splenic/gastroduodenal artery developed in 22 (16.3%), while symptomatic and/or infected pseudocysts - in 23 patients (17.0%). 92 patients (68.1%) underwent surgical intervention. The Frey and Beger procedure was performed in 34, cystogastro/duodenostomy in 48, external drainage and other procedures in 11, distal pancreatectomy with splenectomy in 2 patients. Conservative treatment was successful in 33 (24.5%) cases. ICU treatment was necessary for 64 patients (47.4%), a mean of 4.1 days (range 1- 19). The overall average hospital stay was 17.8 days (range 4-56), the mortality rate for the whole group was 1.5%. Conclusion(s): Surgical intervention is the most common treatment of rare complications of chronic pancreatitis in our institution. The Frey and Beger procedure and internal drainage are associated with low complication and mortality rate; however, minimally invasive treatment should be used more often in the future.