A 62-year-old man undergoes Whipple's pancreaticoduodenectomy for carcinoma of the head of pancreas. On POD 3, drain amylase is 4800 U/L (>3× upper limit of serum amylase). He is clinically well with no fever or abdominal tenderness. This is classified as:
- A Biochemical leak (Grade A POPF); no specific intervention required beyond conservative management ✓
- B Grade B POPF; requires CT-guided drainage
- C Grade C POPF; reoperation mandatory
- D Normal finding; drain amylase is not clinically significant before POD 5
Correct answer: A. Biochemical leak (Grade A POPF); no specific intervention required beyond conservative management
Explanation
The International Study Group of Pancreatic Surgery (ISGPS) classifies postoperative pancreatic fistula (POPF): a biochemical leak (formerly Grade A) is elevated drain amylase (>3× upper limit) without clinical impact and requires only monitoring, with drains left in place. Grade B POPF requires a clinical change in management (prolonged drainage, percutaneous drainage, use of somatostatin analogues). Grade C involves organ failure, reoperation, or death. Most biochemical leaks resolve spontaneously without intervention.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.