Endoscopic management of multiple colonic fistulae secondary to acute pancreatitis (with video).

摘要

A 29-year-old man was transferred to our hospital for management of acute pancreatitis. His medical history was unremarkable except for binge drinking. On physical examination, moderate tenderness of the epigastrium was noted, and initial laboratory test results revealed serum amylase and lipase concentrations of 450 IU/L (normal 60-160 IU/L) and 120 U/L (0-60 U/L), respectively. Abdominal CT scanning disclosed peripancreatic fatty infiltration and fluid collections involving the pancreatic body and tail (arrowheads) (A). The patient was given nothing by mouth as treatment of pancreatitis. One week after the abdominal CT scan, there was improvement of the pancreatitis and pseudocyst; however, complicated cystic lesions showing air-bubble-like densities were still present in the pancreatic tail, and a retroperitoneocolonic fistula was suspected (arrowheads) (B). A virtual colonoscopy was performed, showing the fistula tract (white arrow) on the splenic flexure of the colon (left), and multiple retroperitoneocolonic fistu-lae secondary to acute pancreatitis were diagnosed. A small hole can be seen on the same lesion (right). (C, D).