Tales of the Pancreas

[Roy Danks]

With all due respect to the respondents thus far, and I really mean that, with regard to octreotide: I agree that there is no good evidence that it "works".  I will not and cannot argue that.  But, I will tell you of 2 cases of mine, both penetrating pancreatic injuries with leaks.  After weeks of seemingly unending moderate output fistula, I gave in and put them on octreotide.  Both shut down within a week.  Might they have shut down anyway?  Perhaps.  I'm not touting this as anything but my two cases.
 
It's expensive and with a low output fistula, it probably isn't worth it.  Fortunately/unfortunately, there will probably never be enough pancreatic trauma to study this and obtain any meaningful data.
 
Agree with not doing ERCP.  Sounds like you are managing a potential nightmare (averted).  Kudos to your keen skills and judgment.  Panc injuries are the ones that, I think, make us all take a deep breath and wish we'd listened to our mothers about a career!  :)
 
Have a good day.
 
Roy Danks, DO
General Surgery, Trauma, Burns and Critical Care
Wesley Medical Center
Kansas Surgical Consultants
Wichita, KS
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