Medical Management

Octreotide (synthetic analogue of somatostatin) in doses of 100 mg (SC inj.) has been shown to decrease pancreaticobiliary and gastrointestinal secretions. Although its effectiveness in fistula closure remains unproven. It may even lead to heading of the fistula. Much controversy still exists concerning the use of octreotide especially in light of the excessive cost and uncertain benefits.

H2 blockers and other antacids provide substantial decrease in fistulous output by reducing the stimulatory effect of acid gastric secretion on the bowel.

Antibiotics are frequently utilized because more than 75% of the patients have a local infection with or without abscess. Guidelines are obtained by culture and sensitivity of swab from wound if this is infected. Patients with proven invasive fungus infection are also administered fluconazole or other appropriate antifungals.

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