• Hester C Timmerhuis, Sven M van Dijk, Robbert A Hollemans, Devica S Umans, Christina J Sperna Weiland, Marc G Besselink, BouwenseStefan A WSAWDepartment of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands., Marco J Bruno, Peter van Duijvendijk, van EijckCasper H JCHJDepartment of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Yama Issa, MieogJ Sven DJSDDepartment of Surgery, Leiden University Medical Center, Leiden, The Netherlands., I Quintus Molenaar, StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Thomas L Bollen, Rogier P Voermans, Robert C Verdonk, Hjalmar C van Santvoort, and Dutch Pancreatitis Study Group.
• Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands.
• Ann. Surg. 2023 Aug 1; 278 (2): e284e292e284-e292.

ObjectiveThe aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal (GI) tract in a large unselected cohort of patients with necrotizing pancreatitis.BackgroundPerforation and fistula of the GI tract may occur in necrotizing pancreatitis. Data from large unselected patient populations on the incidence, risk factors, clinical outcomes, and treatment are lacking.MethodsWe performed a post hoc analysis of a nationwide prospective database of 896 patients with necrotizing pancreatitis. GI tract perforation and fistula were defined as spontaneous or iatrogenic discontinuation of the GI wall. Multivariable logistic regression was used to explore risk factors and to adjust for confounders to explore associations of the GI tract perforation and fistula on the clinical course.ResultsA perforation or fistula of the GI tract was identified in 139 (16%) patients, located in the stomach in 23 (14%), duodenum in 56 (35%), jejunum or ileum in 18 (11%), and colon in 64 (40%). Risk factors were high C-reactive protein within 48 hours after admission [odds ratio (OR): 1.19; 95% confidence interval (CI): 1.01-1.39] and early organ failure (OR: 2.76; 95% CI: 1.78-4.29). Prior invasive intervention was a risk factor for developing a perforation or fistula of the lower GI tract (OR: 2.60; 95% CI: 1.04-6.60). While perforation or fistula of the upper GI tract appeared to be protective for persistent intensive care unit-admission (OR: 0.11, 95% CI: 0.02-0.44) and persistent organ failure (OR: 0.15; 95% CI: 0.02-0.58), perforation or fistula of the lower GI tract was associated with a higher rate of new onset organ failure (OR: 2.47; 95% CI: 1.23-4.84). When the stomach or duodenum was affected, treatment was mostly conservative (n=54, 68%). Treatment was mostly surgical when the colon was affected (n=38, 59%).ConclusionsPerforation and fistula of the GI tract occurred in one out of six patients with necrotizing pancreatitis. Risk factors were high C-reactive protein within 48 hours and early organ failure. Prior intervention was identified as a risk factor for perforation or fistula of the lower GI tract. The clinical course was mostly affected by involvement of the lower GI tract.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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