External fistula of the pancreas may be classified as either complete or incomplete. The former commonly involves the intracapitary portion of the duct of Wirsung in such manner that all the pancreatic juice is lost to the body. This event must be exceedingly rare, as the greater number of the reports encountered in the literature deal with external fistula of the incomplete variety, in which there is only a partial loss of pancreatic juice. Duodenal fistula should be differentiated, from the standpoint of classification, because that condition is complicated by the loss not only of pancreatic juice but of bile and duodenal secretion, and therefore grave and often fatal metabolic disturbances occur as a result. Furthermore, the trypsinogen of the pancreatic fluid becomes activated, and digestion of the tissues of the wound in the nearby region of the fistula rapidly ensues.
Perhaps the earliest case of pancreatic fistula recorded was
McCAUGHAN JM, SINNER BL. PANCREATIC FISTULA: MEDICAL AND SURGICAL MANAGEMENT. Arch Surg. 1937;35(3):449–460. doi:10.1001/archsurg.1937.01190150032003
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