Management of upper gastrointestinal bleeding secondary to pancreatogastric fistula from necrotic cavity after necrosectomy

Abstract Text A 63-year-old male with a prolonged hospitalization of 3 months due to necrotizing pancreatitis with superinfected walled-off necrosis (WON) (not endoscopically drainable) and multiple complications. Finally, due to the poor outcome, surgical treatment with subtotal colectomy and necrosectomy was necessary. One month after surgery, he experienced an episode of gastrointestinal bleeding caused by a pancreatogastric fistula from the necrotic cavity. The cavity showed diffuse active bleeding and fistulous tracts. Due to the inability to use the hemostatic spray because of catheter obstruction, hemostatic matrix FLOSEAL was applied (through a naso-cystic tube) into the cavity. Finally, we closed the orifice with an OVESCO clip. The patient showed excellent recovery. The integration of endoscopic and surgical techniques can enhance surgical treatment, especially in high-risk situations [1] [2].

Video  http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/b6e9228e-23ad-481a-a681-a42d05e23aaf/Uploads/16849_Gastric_fistule%20ESGE%202025.mp4

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Kochhar R, Jain K, Gupta V. et al. Fistulization in the GI tract in acute pancreatitis. Gastrointest Endosc 2012; 75: 436-440
• 2 Kwon JC, Kim BY, Kim AL. et al. Pancreatic pseudocystocolonic fistula treated without surgical or endoscopic intervention. World J Gastroenterol 2014; 20: 1882-1886