Spontaneous Fistulization of a Pancreatic Abscess to Colon and Duodenum Treated With Percutaneous Drainage

Abstract

Pancreatic fistulas are rare clinical entities associated with severe pancreatitis. A 39-year-old man who had been diagnosed and treated for severe pancreatitis 2 months ago presented with abdominal pain, fever, and vomiting. The abdominal computed tomography (CT) demonstrated a peripancreatic abscess and a duodenal fistula communicating the first part of duodenum, which was also verified with fluoroscopy. A size 14-French catheter with pig-tail tip was inserted primarily with a Seldinger 2-step technique through percutaneous route under CT-guidance to avoid intervening bowels or solid organs. The patient's clinic improved and treatment was stopped on the 18th day. On the 26th day of the first intervention, the patient had fever and abdominal pain and his clinic was deteriorated. A second fluoroscopic examination revealed that the duodeno pancreatic fistula was closed while a new 1 has developed into the ascending colon. With aggressive nutrition support, antibiotics and repeated drainage of the abscess pouch a dramatic clinical improvement was observed. Control abdominal CT demonstrated the resolution of pancreatic abscess on the 62nd day.

Successful Conservative Management of Pancreatico-Colonic Fistula

“…Hwang et al, have reported closing the fi stula hole endoscopically using hemoclips and biological glue with good outcome [15]. Sezer et al, reported percutaneous drainage of pancreatic abcess which was fi stulized in the ascending colon [18]. Nevertheless, all these techniques are feasible for only well-defi ned pseudocyst or collection and by an experienced operator.…”

Gastroduodenal Artery Psuedoaneurysm Bleed through a Spontaneous Pancreaticoduodenal Fistula as a Result of Acute Necrotizing Pancreatitis

“…The inflammatory process of acute pancreatitis may lead internal fistulization to the GI tract. 10 Spontaneous pancreaticoduodenal fistulas are not uncommon; depending on the study population, the incidence varies from 3% to 47%. 11 - 14 Duodenal and colonic fistulas occur more frequently compared to other sites due to their anatomic proximity.…”

Closure of pancreatoduodenal fistula using vascular occluding coil embolization and fibrin glue injection: a case study

“…The conventional management of pancreatoenteric fistulas and pancreatic abscess with aggressive surgery or percutaneous drainage catheter placement are associated with increased surgery-related morbidity and mortality, and a longer hospitalization. 3 , 4 , 7 , 8 Though the peripancreatic abscess may be addressed by various drainage methods the complete closure of the entire fistula remains difficult. Recently, a variety of occlusion methods of external or internal pancreatic fistula are reported with minimally invasive techniques such as endoscopy and fibrin glue sealant.…”