A Case of Pancreatic Fistula Following Left Nephrectomy: A Rare Complication

TL;DR

A rare case of pancreatic fistula following left nephrectomy is reported, highlighting the importance of early diagnosis and management.

Contribution

This paper presents a rare clinical case of pancreatic fistula after left nephrectomy for a renal pelvis tumor.

Findings

Pancreatic fistula occurred after two laparotomies for a sarcomatoid urothelial carcinoma.

The fistula was managed with somatostatin analogs, parenteral nutrition, and NPO regimen.

The patient's outcome was complicated by intra-abdominal bleeding and septic shock.

Abstract

Pancreatic fistula is a rare but serious complication that may arise following surgery, particularly in oncological procedures. Intraoperative pancreatic injury is an infrequent complication associated with left nephrectomy. We present the case of a 77-year-old male patient who underwent a left nephrectomy for a rare renal pelvis tumor, specifically sarcomatoid urothelial carcinoma. After two consecutive laparotomies, the patient developed a pancreatic fistula, as evidenced by excessive left drain output and elevated amylase levels in the collected fluid. The fistula was managed effectively with subcutaneous somatostatin analog (Sandostatin) injections, parenteral nutrition, and a strict nothing by mouth (NPO) regimen.

This case underscores the potential risk of pancreatic fistula following radical nephrectomy, highlighting the importance of early diagnosis and appropriate management strategies. Unfortunately, the patient's recovery was complicated by intra-abdominal bleeding and septic shock, which ultimately led to his death.

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