Endoscopic Closure of a Pancreatico-Colonic Fistula: A Case Report

TL;DR

This case report describes the successful endoscopic closure of a rare pancreatico-colonic fistula in a patient with severe pancreatitis.

Contribution

The paper presents a novel application of an over-the-scope clip system for non-surgical closure of a pancreatico-colonic fistula.

Findings

The endoscopic procedure using an OTSC system successfully closed the fistula with no leakage confirmed by imaging.

The patient recovered without complications and was able to resume oral intake after the procedure.

Abstract

A known complication of severe pancreatitis is the development of localized collections of necrotic tissue, sometimes leading to the formation of abnormal connections (fistulas) with nearby organs. Some fistulas, such as those involving the stomach or small intestine, may allow drainage of fluid naturally and might not require intervention. However, fistulas involving the colon can lead to serious complications ranging from bleeding to sepsis, with less chance of closure, often needing more invasive treatment.

Traditionally, gastrointestinal fistulas were managed surgically, often through bowel resection or diversion procedures. However, these operations carried significant morbidity. More recently, minimally invasive endoscopic techniques, such as the use of clips or tissue sealants, have emerged as effective alternatives and are increasingly reported as successful options for fistula closure.

We describe a case of a 63-year-old female patient with a history of severe pancreatitis complicated by necrotic collections and a fistula involving the pancreas and colon. Using an endoscopic procedure, an over-the-scope clip (OTSC) system (Ovesco Endoscopy AG, Tübingen, Germany) was placed to close the fistula successfully, confirmed by imaging showing no leakage. Following the procedure, her condition improved, she was gradually reintroduced to oral intake, drains were removed, and she recovered without complications.

There are no standardized guidelines for managing these fistulas without surgery or the optimal endoscopic method for closure. A team-based approach involving multiple specialties is essential to provide the safest and least invasive care.

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