Management of internal and external pancreatic fistulas.

A pancreatic fistula is an uncommon and challenging problem for the general surgeon. Protean in presentation, the underlying pathophysiology of a pancreatic duct disruption is consistent. Several basic principles, when followed, simplify management. These tenets include medical stabilization and nutritional optimization, definition of the underlying duct disorder, and, finally, definitive management with or without surgery. With appropriate prompt care, patients can achieve good outcomes.