GI Surgery & Hepatobiliary · NEET PG Preparation Surgery
A 60-year-old male undergoes a Whipple procedure (pancreatoduodenectomy) for periampullary carcinoma. On postoperative day 5, the drain output increa…
Practice question from GI Surgery & Hepatobiliary (NEET PG Preparation Surgery), with the correct answer and a step-by-step solution.
hard · MCQ · Q-304451
A 60-year-old male undergoes a Whipple procedure (pancreatoduodenectomy) for periampullary carcinoma. On postoperative day 5, the drain output increases to 150 mL/day of clear, yellowish fluid with an amylase level greater than 3 times the serum amylase value. The patient is afebrile and hemodynamically stable. What is the most appropriate initial management?
- A.Immediate exploratory laparotomy and takedown of the pancreaticojejunostomy
- B.Conservative management with somatostatin analogues, maintenance of drain in situ, and nutritional supportCorrect answer
- C.Re-operation for completion pancreatectomy
- D.Broad-spectrum antibiotics and emergency CT-guided percutaneous drain placement
Solution
The patient has a biochemical pancreatic fistula (or low-output grade A/B fistula depending on clinical impact, here clinically stable with an amylase-rich drain fluid on POD 5). Asymptomatic or stable postoperative pancreatic fistulas are managed conservatively with continued drainage, somatostatin analogues (optional/supportive), and adequate nutrition.
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