Post-Whipple procedure on day 5, a patient develops an amylase-rich drain output of 4,500 U/L (>3× upper limit of serum amylase) from the abdominal drain. He is afebrile and tolerating oral diet. Per ISGPF (International Study Group on Pancreatic Fistula) classification, this is:
- A Grade B — requiring drain prolongation or endoscopic intervention
- B Grade C — requiring reoperation
- C Grade A (biochemical leak) — drain removal not required ✓
- D Not a pancreatic fistula as it is only post-operative day 5
Correct answer: C. Grade A (biochemical leak) — drain removal not required
Explanation
ISGPF 2016 revised classification: Grade A (formerly biochemical leak) is amylase-rich drain fluid (>3× serum amylase) on or after day 3 but without any clinical impact, requiring no change in management. Grade B requires drain prolongation >3 weeks, percutaneous drainage, endoscopic intervention, or octreotide use due to clinical impact. Grade C involves organ failure, reoperation, or death. Since this patient is clinically well with no clinical consequence, this is Grade A. The ISGPF definition applies from post-operative day 3 onward.
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.