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A Case Series of Late Gastrointestinal Fistulization in 16 Patients with Walled-Off Necrosis

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Abstract

Background

Gastrointestinal fistulization (GIF) is a rare and potentially fatal complication of acute necrotizing pancreatitis (ANP). There is paucity of data on clinical course and outcome of GIF in walled of necrosis (WON).

Objective

To evaluate frequency, clinical as well as imaging findings and outcome of spontaneous symptomatic GIF in patients with WON.

Methods

Retrospective analysis of database of patients with asymptomatic WON on regular follow-up over last six years to identify patients with symptomatic GIF.

Results

Out of 138 patients with asymptomatic WON seen during the study period, 16 (11.5%) patients (all males; mean age 41.7 ± 9.9 years) developed symptomatic GIF. The mean size of WON in patients who developed GIF was 9.5 ± 2.4 cm, and fistulization occurred after 65.1 ± 17.8 days of the onset of ANP. The site of fistulization was stomach, duodenum, jejunum, colon, and esophagus in seven (43.7%), five (31.2%), one (6.2%), two (12.5%), and one (6.2%) patients, respectively. GIF resulted in spontaneous resolution in two patients (stomach 1 and esophagus 1). The remaining patients with gastric (six patients) and duodenal (five patients) fistulization were successfully treated endoscopically by placing multiple plastic stents in the necrotic cavity after balloon dilatation of the fistulous tract. Patients with colonic fistulization required surgery. None of the patients succumbed to the illness.

Conclusion

Symptomatic GIF of WON usually occurs within the first three months of onset of ANP. It commonly occurs in either stomach or duodenum and can be successfully managed endoscopically.

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References

  1. Rana SS. An overview of walled-off pancreatic necrosis for clinicians. Expert Rev Gastroenterol Hepatol 2019;13:331–343

    Article  CAS  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  3. Danilov MV, Vishnevskii VA, Kaltaev KK. External gastric and intestinal fistulas as a complication of acute pancreatitis. Vestn Khir Im I I Grek 1972;107:122–123

    CAS  PubMed  Google Scholar 

  4. Kochhar R, Jain K, Gupta V et al. Fistulization in the GI tract in acute pancreatitis. Gastrointest Endosc 2012;75:436–440

    Article  Google Scholar 

  5. Jiang W, Tong Z, Yang D et al. Gastrointestinal fistulas in acute pancreatitis with infected pancreatic or peripancreatic necrosis: a 4-year single-center experience. Medicine (Baltimore) 2016;95:e3318

    Article  Google Scholar 

  6. Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg 1995;130:48–52

    Article  CAS  Google Scholar 

  7. Gao L, Zhang JZ, Gao K et al. Management of colonic fistulas in patients with infected pancreatic necrosis being treated with a step-up approach. HPB 2020;22:1738–1744

    Article  Google Scholar 

  8. Shen D, Ning C, Huang G et al. Outcomes of infected pancreatic necrosis complicated with duodenal fistula in the era of minimally invasive techniques. Scand J Gastroenterol 2019;54:766–772

    Article  Google Scholar 

  9. Banks PA, Bollen TL, Dervenis C et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102

    Article  Google Scholar 

  10. Rana SS, Sharma RK, Gupta P et al. Natural course of asymptomatic walled off pancreatic necrosis. Dig Liver Dis 2019;51:730–734

    Article  Google Scholar 

  11. Boopathy V, Balasubramanian P, Alexander T et al. Spontaneous fistulisation of infected walled-off necrosis (WON) into the duodenum in a patient following acute necrotising pancreatitis. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2013-202863.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Inoue H, Yamada R, Takei Y. Spontaneous fistulization of infected walled-off pancreatic necrosis into the duodenum and colon. Dig Endosc 2014;26:293

    Article  Google Scholar 

  13. Rerknimitr R, Lakananurak N, Prueksapanich P et al. A fatal case of a colonic fistula communicating with a walled-off area of pancreatic necrosis. Endoscopy 2014;46:E30–E31

    PubMed  Google Scholar 

  14. Rana SS, Sharma V, Gorka S et al. Creation of multiple transluminal gateway during endoscopic ultrasound-guided drainage of pancreatic necrosis by enlarging tract of impending rupture in duodenum. Endosc Ultrasound 2015;4:257–259

    Article  Google Scholar 

  15. Rana SS, Sharma V, Sharma R et al. Gastrointestinal: spontaneous cysto-esophageal fistula leading to resolution of walled off pancreatic necrosis. J Gastroenterol Hepatol 2016;31:1799

    Article  Google Scholar 

  16. Rana SS, Bhasin DK, Sharma RK et al. Do the morphological features of walled off pancreatic necrosis on endoscopic ultrasound determine the outcome of endoscopic transmural drainage? Endosc Ultrasound 2014;3:118–122

    Article  Google Scholar 

  17. Rana SS, Bhasin DK, Reddy YR et al. Morphological features of fluid collections on endoscopic ultrasound in acute necrotizing pancreatitis: do they change over time? Ann Gastroenterol 2014;27:258–261

    PubMed  PubMed Central  Google Scholar 

  18. Gupta R, Kulkarni A, Babu R et al. Complications of percutaneous drainage in step-up approach for management of pancreatic necrosis: experience of 10 years from a tertiary care center. J Gastrointest Surg 2020;24:598–609

    Article  Google Scholar 

  19. Mohamed SR, Siriwardena AK. Understanding the colonic complications of pancreatitis. Pancreatology 2008;8:153–158

    Article  Google Scholar 

  20. James TW, Moran RA, Ngamruengphong S et al. Endoscopic transmural necrosectomy through spontaneous pancreaticoduodenal fistula. Gastrointest Endosc 2016;83:255–256

    Article  Google Scholar 

  21. Maatman TK, Nicolas ME, Roch AM et al. Colon involvement in necrotizing pancreatitis: incidence, risk factors, and outcomes. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000004149.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Surinder Singh Rana, Ravi Sharma & Lovneet Dhalaria

  2. Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Mandeep Kang

  3. Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Rajesh Gupta

Authors
  1. Surinder Singh Rana
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  2. Ravi Sharma
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  3. Lovneet Dhalaria
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  4. Mandeep Kang
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  5. Rajesh Gupta
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Contributions

Surinder Singh Rana contributed to collection and interpretation of data, drafting of manuscript, and design of study. Ravi Sharma contributed to collection and interpretation of data and final approval of the manuscript. Lovneet Dhalaria contributed to collection and interpretation of data and final approval of the manuscript. Mandeep Kang contributed to collection and interpretation of data and final approval of the manuscript. Rajesh Gupta contributed to collection and interpretation of data and final approval of the manuscript.

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Correspondence to Surinder Singh Rana.

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Rana, S.S., Sharma, R., Dhalaria, L. et al. A Case Series of Late Gastrointestinal Fistulization in 16 Patients with Walled-Off Necrosis. Dig Dis Sci 67, 661–666 (2022). https://doi.org/10.1007/s10620-021-06900-y

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  • DOI: https://doi.org/10.1007/s10620-021-06900-y

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