title: Severe Acute Pancreatitis with Complicating Colonic Fistula Successfully Closed Using the Over-the-Scope Clip System.
abstract: A 44-year-old man presenting to our hospital emergency room with abdominal pain was hospitalized for hyperlipidemic acute pancreatitis. A pig-tail catheter was placed percutaneously to drain an abscess on day 22. Although the abscess improved gradually and good clinical progress was seen, pancreatic duct disruption was strongly suspected and endoscopic retrograde cholangiopancreatography was performed on day 90. An endoscopic nasopancreatic drainage tube was placed, but even with concurrent use of a somatostatin analogue, treatment was ineffective. Surgical treatment was elected, but was subsequently postponed as the abscess culture was positive for extended-spectrum β-lactamase-producing Escherichia coli and methicillin-resistant Staphylococcus aureus. Drainage tubography showed a small fistula of the colon at the splenic flexure on day 140. Colonoscopy was performed on day 148. After indigo carmine had been injected, a fistula into the splenic flexure of the colon showed blue staining. The over-the-scope clip (OTSC) system was used to seal the fistula and complete closure was shown. A liquid diet was started on day 159 and was smoothly upgraded to a full diet. Following removal of the pancreatic stent on day 180, drainage volume immediately decreased and the percutaneous drain was removed. On day 189, computed tomography showed no exacerbation of the abscess and the patient was discharged on day 194. This case of colonic fistula caused by severe acute pancreatitis was successfully treated using the OTSC system, avoiding the need for an open procedure.
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ito
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Mimura
authors.forename: Yui
authors.initials: Y
authors.lastname: Kishimoto
authors.forename: Itaru
authors.initials: I
authors.lastname: Kamata
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Yoshimoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Okano
keywords: Colonic fistula; Endoscopic treatment; Pancreatic duct disruption; Severe acute pancreatitis
references.citation: Am J Gastroenterol. 2006 Oct;101(10):2379-400
references.pmid: 17032204
references.citation: Ann Surg. 2000 Mar;231(3):361-7
references.pmid: 10714629
references.citation: Pancreatology. 2001;1(6):668-73
references.pmid: 12120252
references.citation: Ann Surg. 2009 Dec;250(6):872-7
references.pmid: 19953707
references.citation: Br J Surg. 2012 Jun;99(6):754-60
references.pmid: 22430616
references.citation: J Gastroenterol Hepatol. 2010 Jun;25(6):1087-92
references.pmid: 20594223
references.citation: Gastrointest Endosc. 2007 Jul;66(1):162-7
references.pmid: 17591492
references.citation: Dig Liver Dis. 2003 Dec;35(12):907-10
references.pmid: 14703889
references.citation: J Clin Gastroenterol. 2003 Sep;37(3):258-62
references.pmid: 12960726
references.citation: Gut. 2001 Dec;49 Suppl 4:iv11-21
references.pmid: 11878789
references.citation: Arch Surg. 1995 Aug;130(8):817-22; discussion 822-3
references.pmid: 7632140
references.citation: Arch Surg. 1979 Sep;114(9):995-1001
references.pmid: 485850
references.citation: Br J Surg. 2001 Jul;88(7):975-9
references.pmid: 11442530
references.citation: Endoscopy. 2009 Jun;41(6):481-6
references.pmid: 19533550