title: Pancreaticocolonic fistulas secondary to severe acute pancreatitis treated by percutaneous drainage: successful nonsurgical outcomes in a single-center case series.
abstract: OBJECTIVE
  Pancreaticocolonic fistulas (PCFs) are uncommon complications of acute necrotizing pancreatitis (ANP). Studies advocating primary surgical treatment showed severe morbidity and mortality with nonsurgical treatment, with survival rates of approximately 50%. However, a nonsurgical treatment scheme with primary percutaneous drainage and other interventions may show improved outcomes. This retrospective single-center study describes the presentation, diagnosis, course, treatment strategy, and outcome of successfully treated PCFs, with an emphasis on nonsurgical interventions.
  
  
  METHODS
  Twenty patients with PCFs caused by ANP were treated with percutaneous drainage and medical therapy. Additional interventions included endoscopic transenteric drainage and pancreatic duct (PD) stent placement. Surgery was reserved for patients in whom this nonsurgical management failed.
  
  
  RESULTS
  All PCFs closed during a median follow-up of 56 days (mean, 106 d; range, 13-827 d). Treatment included percutaneous drainage of the PCF-related collection in all patients, PD stents in 60%, transenteric drainage in 15%, and definitive surgery in 15%. Indications for surgery included severe PCF-related symptoms, large feculent peritoneal collection, and colonic stricture. Two patients (10%) died, one of complications of ANP and one of esophageal carcinoma. Additional enteric fistulas were identified in 50% of patients. Median time from the most recent diagnosis of pancreatitis to PCF diagnosis was 89 days (mean, 113 d; range, 13-394 d).
  
  
  CONCLUSIONS
  A nonsurgical approach to PCFs caused by ANP, including percutaneous drainage and other techniques, yields good survival, with surgery reserved for cases in which this approach fails.
authors.affiliation: Department of Radiology, Virginia Mason Medical Center, Seattle, WA 98101, USA. heeter@gmail.com
authors.forename: Zachary R
authors.initials: ZR
authors.lastname: Heeter
authors.forename: Ellen
authors.initials: E
authors.lastname: Hauptmann
authors.forename: Robert
authors.initials: R
authors.lastname: Crane
authors.forename: Mehran
authors.initials: M
authors.lastname: Fotoohi
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Justin
authors.initials: J
authors.lastname: Siegal
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology* / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult