A 65-year-old woman undergoes a Whipple procedure (pancreaticoduodenectomy) for a 2.8 cm pancreatic head adenocarcinoma. On postoperative day 4, the drain amylase level is 4,200 U/L (>3x upper limit of serum amylase). The patient is clinically stable with no fever and tolerating oral fluids. According to the International Study Group on Pancreatic Fistula (ISGPF) classification, this is:
- A Grade B POPF — requires interventional drainage or octreotide
- B Grade C POPF — requires re-operation
- C Not a POPF — drain amylase >1000 U/L is normal after Whipple
- D Grade A postoperative pancreatic fistula (POPF) — biochemical leak, conservative management ✓
Explanation
ISGPF (2016 revised definition) defines POPF as drain amylase >3x upper limit of normal serum amylase on or after POD 3. Grade A (biochemical leak) is clinically irrelevant, patient is stable, no clinical impact, and drain is removed without any specific intervention. Grade B requires prolonged drainage (>3 weeks), percutaneous drainage, or octreotide — patient is clinically stable but drain cannot be removed. Grade C represents life-threatening fistula with organ failure/re-operation required. This patient has Grade A (no fever, tolerating orals, otherwise stable). Management is conservative: drain removal or reduction.
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.