Pancreatic choledochal fistula complicating acute pancreatitis

Brar, Rahat; Singh, Iqbal; Brar, Preetinder; Prasad, Abhishek; Doley, Rudra Prasad; Wig, Jai Dev

doi:10.12659/ajcr.882600

Cited by 6 publications

(6 citation statements)

References 18 publications

(31 reference statements)

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“…In our case, biliary fistula was not evident on CT scan since classical signs such as air into the biliary tree or interruption of choledocal wall opening into the WOPN were not visible; however, the appearance of bile in the WOPN cavity during necrosectomy may be considered a direct sign of biliary fistula [ 32 ]. ERCP confirmed the presence of biliary fistula involving distal common bile duct.…”

Section: Discussionmentioning

confidence: 99%

“…ERCP confirmed the presence of biliary fistula involving distal common bile duct. Management options include primary reconstruction of bile duct with or without Kehr tube, biliary diversion, and in extremis, pancreaticoduodenectomy [ 9 , 32 – 34 ]. Since the biliary lesion appeared to be small, a stenting was decided with resolution of the leak.…”

Section: Discussionmentioning

confidence: 99%

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Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review

et al. 2017

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BackgroundCurrently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting. Moreover, a systematic literature review of comparative studies on minimally invasive techniques in necrotizing pancreatitis has been provided.Case presentationA 59-year-old patient was referred to our center for acute necrotizing pancreatitis associated with multi-organ failure. No invasive procedures were attempted in the first month from the onset: enteral feeding by a naso-duodenal tube was started, and antibiotics were administered to control sepsis. After 4 weeks, CT scans showed a central walled-off pancreatic necrosis (WOPN) of pancreatic head communicating bilateral retroperitoneal collections. ETN was performed, and bile leakage was found at the right margin of the WOPN. Endoscopic retrograde cholangiopancreatography confirmed the presence of a choledocal fistula within the WOPN, and a biliary stent was placed. An ultrasound-guided PD was performed on the left retroperitoneal collection. Due to the subsequent repeated onset of septic shocks and the evidence of size increase of the right retroperitoneal collection, a VARD was decided. The CT scans documented the resolution of all the collections, and the patient promptly recovered from sepsis. After 6 months, the patient is in good clinical condition.ConclusionsNo mini-invasive technique has demonstrated significantly better outcomes over the others, and each technique has specific indications, advantages, and pitfalls. Indeed, ETN could be suitable for central WOPNs, while VARD or PD could be suggested for lateral collections. A combination of different approaches is feasible and could significantly optimize the clinical management in critically ill patients affected by complicated necrotizing pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review

et al. 2017

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“…Following severe necrotizing pancreatitis, the most common cause for the bile leak either spontaneously or following surgery is the duodenal fistula [ 3 , 4 ]. Rarely, it can be due to the erosion of the distal common bile duct by the peri-pancreatic necrosis [ 5 , 6 ]. Though it presents early following intervention, in the present case the bile leak became obvious only after the third week of necrosectomy after discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Post-pancreatic necrosectomy biliary fistula: thinking beyond the box

Pandit

Awale

Deo

et al. 2021

Journal of Surgical Case Reports

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Walled-off pancreatic necrosis is a challenging problem and pancreatic necrosectomy is associated with significant morbidity and mortality. Following necrosectomy, postoperative bile leak is a rare complication. We present such a case of delayed bile leak from the distal common bile duct in an 81-year-old lady following pancreatic necrosectomy, which was successfully managed by endoscopic stenting.

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“…A pancreaticobiliary fistula is considered a rare condition and is generally associated with pancreatic pseudocysts and acute necrotizing pancreatitis. 1 , 2 , 3 Often, the fistula is managed by deployment of a plastic stent in the pancreatic duct, which may lead to closure of the fistula. 4 Cholangitis due to pancreaticobiliary fistula has only been described in cases of intraductal papillary mucinous neoplasms or impacted pancreatic stones.…”

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confidence: 99%