Pancreatic Emergencies in the Cancer Patient

  • Oliver S. Eng
  • Laleh G. Melstrom


Pancreatic malignancy without treatment presents a grim prognosis. Yet, modalities involved in the treatment of this disease are not without potential complications. Complications, particularly postsurgical, are well reported in the literature. Pancreatic emergencies are a dangerous subset of complications related to this disease, frequently requiring expeditious decision making and management. In this chapter, we review the diagnostic workup, treatment, and sequelae of pancreatic emergencies.


Pancreatic cancer Pancreatitis Endoscopic retrograde cholangiopancreatography (ERCP) 


  1. 1.
    Valsangkar N, Thayer S. The pancreas. In: Cameron JL, Cameron A, editors. Current surgical therapy. 11th ed. Philadelphia: Elsevier Saunders; 2014. p. 431–9.Google Scholar
  2. 2.
    Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc. 2015;81(1):143–9. e9.CrossRefPubMedGoogle Scholar
  3. 3.
    Elmunzer BJ, Scheiman JM, Lehman GA, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 2012;366(15):1414–22.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy. 2003;35(10):830–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Wang P, Li ZS, Liu F, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009;104(1):31–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Thaker AM, Mosko JD, Berzin TM. Post-endoscopic retrograde cholangiopancreatography pancreatitis. Gastroenterol Rep. 2015;3(1):32–40.CrossRefGoogle Scholar
  8. 8.
    Sethi S, Sethi N, Wadhwa V, Garud S, Brown A. A meta-analysis on the role of rectal diclofenac and indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2014;43(2):190–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Dumonceau JM, Andriulli A, Elmunzer BJ, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—updated June 2014. Endoscopy. 2014;46(9):799–815.CrossRefPubMedGoogle Scholar
  10. 10.
    Fung AS, Tsiotos GG, Sarr MG. ERCP-induced acute necrotizing pancreatitis: is it a more severe disease? Pancreas. 1997;15(3):217–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Bradley 3rd EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Rohan Jeyarajah D, Osman HG, Patel S. Severe acute pancreatitis attacks are associated with significant morbidity and mortality. Curr Probl Surg. 2014;51(9):370–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Jafri NS, Mahid SS, Idstein SR, Hornung CA, Galandiuk S. Antibiotic prophylaxis is not protective in severe acute pancreatitis: a systematic review and meta-analysis. Am J Surg. 2009;197(6):806–13.CrossRefPubMedGoogle Scholar
  14. 14.
    van Santvoort HC, Besselink MG, Horvath KD, et al. Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. HPB (Oxford). 2007;9(2):156–9.CrossRefGoogle Scholar
  15. 15.
    Pascual I, Sabater L, Anon R, et al. Surgical versus nonsurgical treatment of infected pancreatic necrosis: more arguments to change the paradigm. J Gastrointest Surg. 2013;17(9):1627–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Thandassery RB, Yadav TD, Dutta U, Appasani S, Singh K, Kochhar R. Prospective validation of 4-category classification of acute pancreatitis severity. Pancreas. 2013;42(3):392–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220(4):530–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Glebova NO, Hicks CW, Piazza KM, et al. Technical risk factors for portal vein reconstruction thrombosis in pancreatic resection. J Vasc Surg. 2015;62(2):424–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Pratt WB, Callery MP, Vollmer Jr CM. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg. 2008;32(3):419–28.CrossRefPubMedGoogle Scholar
  20. 20.
    Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer Jr CM. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.CrossRefPubMedGoogle Scholar
  21. 21.
    Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.CrossRefPubMedGoogle Scholar
  22. 22.
    Klek S, Sierzega M, Turczynowski L, Szybinski P, Szczepanek K, Kulig J. Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial. Gastroenterology. 2011;141(1):157–63. 163.e1.CrossRefPubMedGoogle Scholar
  23. 23.
    Allen PJ, Gonen M, Brennan MF, et al. Pasireotide for postoperative pancreatic fistula. N Engl J Med. 2014;370(21):2014–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Lowy AM, Lee JE, Pisters PW, et al. Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Ann Surg. 1997;226(5):632–41.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg. 2000;232(3):419–29.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sarr MG, Pancreatic SG. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg. 2003;196(4):556–64; discussion 64–5; author reply 65.CrossRefPubMedGoogle Scholar
  27. 27.
    Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Grutzmann R, Ruckert F, Hippe-Davies N, Distler M, Saeger HD. Evaluation of the International Study Group of Pancreatic Surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery. 2012;151(4):612–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Wellner UF, Kulemann B, Lapshyn H, et al. Postpancreatectomy hemorrhage—incidence, treatment, and risk factors in over 1,000 pancreatic resections. J Gastrointest Surg. 2014;18(3):464–75.CrossRefPubMedGoogle Scholar
  30. 30.
    Nentwich MF, El Gammal AT, Lemcke T, et al. Salvage completion pancreatectomies as damage control for post-pancreatic surgery complications: a single-center retrospective analysis. World J Surg. 2015;39(6):1550–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Csendes A, Torres J, Burgos AM. Late marginal ulcers after gastric bypass for morbid obesity. Clinical and endoscopic findings and response to treatment. Obes Surg. 2011;21(9):1319–22.CrossRefPubMedGoogle Scholar
  32. 32.
    Wendling MR, Linn JG, Keplinger KM, et al. Omental patch repair effectively treats perforated marginal ulcer following Roux-en-Y gastric bypass. Surg Endosc. 2013;27(2):384–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Moon RC, Teixeira AF, Goldbach M, Jawad MA. Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surg Obes Relat Dis. 2014;10(2):229–34.CrossRefPubMedGoogle Scholar
  34. 34.
    Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Surgical OncologyCity of Hope Cancer CenterDuarteUSA
  2. 2.Surgical Oncology, Department of SurgeryCity of Hope Cancer Center, Beckman Research InstituteDuarteUSA

Personalised recommendations