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Wed Jun 27 19:31:57 BST 2007

Roy et all,

That has been my experience with sandostatin - it worked on 4 very tough cases for me when all else failed.  Luck?  perhaps, but I would much rather be lucky than good.

I was lucky enough to work with John Ranson for my years at NYU and Bellevue as a medical student and resident - and he always referred to the pancreaticoduodenal complex as "Tiger Country, where even real men fear to tread".  How right he was!

Ron

>>> Roy Danks <roydanks at hotmail.com> 6/27/2007 11:36 AM >>>
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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