Diagnosis of gastrointestinal fistulas in pancreatic necrosis by X-ray and computed tomography

The purpose of the study: to clarify the possibilities of using X-ray research methods in the framework of a comprehensive diagnosis of gastrointestinal fistulas in pancreatic necrosis.

Materials and methods. The analysis of the results of X-ray examination of 23 patients with pancreatic necrosis complicated by the formation of gastrointestinal tract fistulas (GI tract) is presented. All patients underwent computed tomography (CT) of the abdominal cavity and retroperitoneal space with bolus contrast enhancement and X-ray fistulography. Contrast examination of the upper gastrointestinal tract after oral administration of a water-soluble contrast agent and CT fistulography were used as additional research methods.

Results. During the examination, 27 gastrointestinal fistulas were detected in 23 patients. In all 23 patients, CT examination revealed signs of pancreatic necrosis and parapancreatitis with the presence of fluid and necrotic accumulations that were drained. CT scan revealed indirect signs of gastrointestinal fistulas, such as: the location of the gastrointestinal tract bearing the fistula in the zone of pancreatogenic destruction (100%), thickening of the intestinal wall or stomach (100%), gas inclusions in adjacent sections of fiber (59%). Direct signs of gastrointestinal fistulas were detected by X-ray fistulography in 22 cases (81%) in the form of leakage of CA into the lumen of the intestine or stomach. In 5 patients (19%) with fistula of the duodenum, there were no direct signs of fistula during fistulography. In almost all of these observations (21 cases out of 22 95%), fistulography revealed a cavity of pancreatogenic destruction through which the fistula communicated with the intestine or stomach. At the stages of pancreatic necrosis treatment, CT monitoring was performed in all 23 patients to identify new areas of necrosis and fluid accumulations, and to assess the location of drainage tubes in relation to the intestinal wall. Dynamic X-ray fistulography (20 observations) was used to evaluate the effectiveness of treatment of fistula and the state of the destruction cavity.

Conclusion. X-ray fistulography makes it possible to diagnose gastrointestinal fistulas in patients with pancreatic necrosis with a sensitivity of 81% in general and 100% when the fistula is localized in the colon. To increase the information content in the detection of small intestinal fistulas, it is advisable to use an X-ray contrast examination of the gastrointestinal tract. At the same time, CT additionally allows you to assess the condition of the pancreatic parenchyma and parapancreatic fiber, and determine therapeutic tactics. X-ray monitoring using CT and X-ray fistulography is an integral component of the therapeutic and diagnostic algorithm in patients with gastrointestinal fistulas in pancreatic necrosis.

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