A 68-year-old man undergoes Whipple's procedure (pancreaticoduodenectomy) for pancreatic head carcinoma. On postoperative day 3, drain amylase is 4500 U/L (>3× upper limit of normal serum amylase). He is clinically stable with no fever. According to ISGPS criteria, this is classified as:
- A Grade B POPF requiring radiological intervention
- B Grade C POPF requiring reoperation
- C Grade A postoperative pancreatic fistula — biochemical leak, managed conservatively ✓
- D Normal post-Whipple drain output, no fistula classification applies
Correct answer: C. Grade A postoperative pancreatic fistula — biochemical leak, managed conservatively
Explanation
The International Study Group on Pancreatic Fistula (ISGPS) 2016 revised classification defines a biochemical leak (previously Grade A) as drain amylase >3× upper normal serum amylase without clinical impact — no change in management or imaging, no prolonged drainage or intervention needed. Grade B POPF requires clinical deviation: prolonged drain (>3 weeks), change in management (antibiotics, nutritional support, repositioning of drain). Grade C requires reoperation, end-organ failure, or death. Clinical stability and absence of fever confirm Grade A here.
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.