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Traitement endoscopique d’une fistule colique due à une pancréatite aiguë nécrosante : à propos d’un cas

Endoscopic management of colonic fistula due to necrotizing acute pancreatitis: report of a case

  • Cas Clinique / Case Report
  • Published:
Acta Endoscopica

Résumé

Les pancréatites aiguës sévères se compliquent de fistules coliques dans environ 3 à 5 % des cas. Le traitement de référence est une prise en charge chirurgicale avec souvent dérivation digestive temporaire. Nous reportons le cas d’un homme de 37 ans présentant une fistule colique après pancréatite aiguë nécrosante. Avant la mise en évidence de la fistule, un pseudokyste a fait l’objet d’un drainage transgastrique perendoscopique. Devant la persistance d’un état septique, le patient a été adressé dans notre centre. Une nécrosectomie endoscopique a été réalisée et un drain nasokystique a été mis en place pour lavages itératifs. Une fistule kystocolique a été mise en évidence de manière fortuite lors de l’opacification via ce drain. Un traitement médical a été ensuite conduit avec antibiotiques, antifongique adaptés aux différents prélèvements, dérivés de la somatostatine ainsi que drainage percutané sous scanner d’une collection dans le flanc gauche. Après lavages itératifs via les deux drains, l’opacification de contrôle ne montrait plus de fistule, les drains ont été retirés sans récidive à ce jour.

Abstract

Severe acute pancreatitis is associated with a colonic fistula in about 3–5% of cases. The gold-standard is a surgical treatment, often with temporary colostomy or ileostomy. We report the case of a 37-year-old man with acute necrotizing pancreatitis with colic fistula treated by endoscopic and percutaneous drainage. Initially, a transgastric drainage with placement of two pigtail stents was achieved. Given the persistence of sepsis, the patient was referred to our center. Endoscopic necrosectomy was performed and a nasocystic drain allowed to wash the necrosis cavity. Cystcolonic fistula has been found during the opacification.

Medical treatment was then carried out with antibiotics, antifungal, somatostatin derivatives and percutaneous drainage under CT-scanner of a collection in the left flank.

After iterative washes through the two drains, opacification control showed no persistent fistula. Drains were removed without recurrence to date of the colonic fistula.

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Références

  1. Barthet M, Bugallo M, Moreira LS, Bastid C, Sastre B, Sahel J. Traitement des pseudokystes de pancréatite aiguë etude retrospective de 45 patients. Gastroenterol Clin Biol 1992;16:853–859.

    CAS  PubMed  Google Scholar 

  2. Sbrocchi RD, Anderson MC. Erosion of adjacent organs by pancreatic pseudocysts. Am Surg 1984;50:85–90.

    CAS  PubMed  Google Scholar 

  3. Adams DB, Davis BR, Anderson MC. Colonic complications of pancreatitis. Am Surg 1994;60:44–49.

    CAS  PubMed  Google Scholar 

  4. Abcarian H, Eftaiha M, Kraft AR, Nyhus LM. Colonic complications of acute pancreatitis. Arch Surg. 1979;114:995–1001.

    Article  CAS  PubMed  Google Scholar 

  5. Russell JC, Welch JP, Clark DG. Colonic complications of acute pancreatitis and pancreatic abscess. Am J Surg 1983;146:558–564.

    Article  CAS  PubMed  Google Scholar 

  6. Aletras H, Eleftheriadis E. Colonic fistulization with rectal bleeding: a rare complication in acute necrotizing pancreatitis. World J Surg 1989;13:823.

    Article  CAS  PubMed  Google Scholar 

  7. Aldridge MC, Francis ND, Glazer G, Dudley HA. Colonic complications of severe acute pancreatitis. Br J Surg. 1989;76:362–367.

    Article  CAS  PubMed  Google Scholar 

  8. Negro P, D’Amore L, Flati G, Gossetti F, Guadagni S, De Bernardinis G, et al. Colonic involvement in pancreatitis. Six cases more. Int Surg 1991;76:122–126.

    CAS  Google Scholar 

  9. Negro P, D’Amore L, Saputelli A, Talarico C, Scaccia M, Tuscano D, et al. Colonic lesions in pancreatitis. Ann Ital Chir 1995;66:223–231.

    CAS  PubMed  Google Scholar 

  10. Adams DB, Davis BR, Anderson MC. Colonic complications of pancreatitis. Am Surg 1994;60:44–49.

    CAS  PubMed  Google Scholar 

  11. Ho HS, Frey CF. Gastrointestinal and pancreatic complications associated with severe pancreatitis. Arch Surg 1995;130:817–822.

    Article  CAS  PubMed  Google Scholar 

  12. Van Minnen LP, Besselink MG, Bosscha K, Van Leeuwen MS, Schipper ME, Gooszen HG. Colonic involvement in acute pancreatitis. A retrospective study of 16 patients. Dig Surg 2004;21:33–38.

    Google Scholar 

  13. Suzuki A, Suzuki S, Sakaguchi T, Oishi K, Fukumoto K, Ota S, et al. Colonic fistula associated with severe acute pancreatitis: report of two cases. Surg Today 2008;38:178–183.

    Article  PubMed  Google Scholar 

  14. Kochhar R, Jain K, Gupta V, Singhal M, Kochhar S, Poornachandra KS, et al. Fistulization in the GI tract in acute pancreatitis. Gastrointest Endosc 2012;75:436–440.

    Article  PubMed  Google Scholar 

  15. Van Minnen LP, Besselink MG, Bosscha K, Van Leeuwen MS, Schipper ME, Gooszen HG. Colonic involvement in acute pancreatitis. A retrospective study of 16 patients. Dig Surg 2004;21:33–38.

    Google Scholar 

  16. Bakker OJ1, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Dutch Pancreatitis Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012;307:1053–1061.

    Article  CAS  PubMed  Google Scholar 

  17. Gardner TB, Coelho-Prabhu N, Gordon SR, Gelrud A, Maple JT, Papachristou GI, et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. Series. Gastrointest Endosc 2011;73:718–726.

    Article  PubMed  Google Scholar 

  18. Ang TL, Teo EK, Fock KM. Endoscopic drainage and endoscopic necrosectomy in the management of symptomatic pancreatic collections. J Dig Dis 2009;10:213–224.

    Article  PubMed  Google Scholar 

  19. Seifert H, Biermer M, Schmitt W, Jürgensen C, Will U, Gerlach R, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009;58:1260–1266.

    Article  CAS  PubMed  Google Scholar 

  20. Howell DA, Dy RM, Gerstein WH, Hanson BL, Biber BP. Infected pancreatic pseudocysts with colonic fistula formation successfully managed by endoscopic drainage alone: report of two cases. Am J Gastroenterol 2000;95:1821–1823.

    Article  CAS  PubMed  Google Scholar 

  21. Hwang SO, Lee TH, Park JW, Park SH, Kim SJ. Endoscopic management of multiple colonic fistulae secondary to acute pancreatitis (with video). Gastrointest Endosc 2010:71:395–397.

    Article  PubMed  Google Scholar 

  22. Ishiwatari H, Hayashi T, Yoshida M, Jomen W, Miyanishi K, Sato T, et al. A case of pancreatic abscess associated with colonic fistula successfully treated by endoscopic transgastric drainage using a metallic stent. Clin J Gastroenterol 2011;4:331–335.

    Article  Google Scholar 

  23. Sezer A, Sagiroglu T, Temizoz O, Yagci MA, Umit GE, Umit H. Spontaneous fistulization of a pancreatic abscess to colon and duodenum treated with percutaneous drainage. Surg Laparosc Endosc Percutan Tech 2011;21:e138–140.

    Article  PubMed  Google Scholar 

  24. Gray DM 2nd, Mullady DK. Attempted endoscopic closure of a pancreaticocolonic fistula with an over-the-scope clip. JOP 2012;13:712–714.

    PubMed  Google Scholar 

  25. Fujii K, Suzuki K, Goto A, Nakahata K, Matsunaga Y, Wakasugi H, et al. Pancreatic-colonic fistula successfully treated with endoscopic transpapillary nasopancreatic drainage. Endoscopy 2011;43 Suppl 2 UCTN:E154–E155.

    Article  Google Scholar 

  26. Tüney D, Altun E, Barlas A, Yegen C. Pancreatico-colonic fistula after acute necrotizing pancreatitis. Diagnosis with spiral CT using rectal water soluble contrast media. JOP 2008;9:26–29.

    Google Scholar 

  27. De Backer AI, Mortelé KJ, Vaneerdeweg W, Ros PR. Pancreatocolonic fistula due to severe acute pancreatitis: imaging findings. JBR-BTR 2001;84:45–47.

    PubMed  Google Scholar 

  28. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491–1502.

    Article  PubMed  Google Scholar 

  29. Rau B, Bothe A, Beger HG. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19 year, single-center series. Surgery 2005;138:28–39.

    Article  CAS  PubMed  Google Scholar 

  30. Rodriguez JR, Razo AO, Targarona J, Thayer SP, Rattner DW, Warshaw AL, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 2008;247:294–299.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hôpital de la Conception, service d’hépatogastroentérologie et pancréatologie, 147 boulevard Baille, F-13005, Marseille, France

    J. P. Ratone, X. Truchet & L. Heyries

  2. CHU de la Conception, service d’hépatogastroentérologie, 147 boulevard Baille, F-13005, Marseille, France

    J. P. Bernard

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  1. J. P. Ratone
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  2. X. Truchet
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  3. J. P. Bernard
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  4. L. Heyries
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Correspondence to J. P. Ratone.

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Ratone, J.P., Truchet, X., Bernard, J.P. et al. Traitement endoscopique d’une fistule colique due à une pancréatite aiguë nécrosante : à propos d’un cas. Acta Endosc 44, 190–193 (2014). https://doi.org/10.1007/s10190-014-0381-1

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  • DOI: https://doi.org/10.1007/s10190-014-0381-1

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