Abstract
A 49-year-old man was hospitalized for acute pancreatitis and pancreatic pseudocysts. Symptoms and blood test results improved with fasting and antibiotic administration and oral feeding was initiated. However, fever reemerged and his inflammatory response was exacerbated. On abdominal computed tomography (CT), gas was observed within the pancreatic cyst and intracyst infection was suspected. Endoscopic ultrasound (EUS)-guided transgastric cyst drainage, i.e., placement of an internal and external drainage tube, was performed. At postoperative one week, his inflammatory response had normalized. However, when contrast imaging was performed via the external drainage tube with the aim of removing the tube, the descending colon was visualized and colonic fistula was still clearly visible. It was expected that the fistula would close on its own with conservative therapy ; therefore, he was kept under observation under NPO and antibiotic treatment. On CT performed about 20 days later, the abscess was no longer visible. After oral feeding was reinitiated, his course was favorable and was discharged. Colonic fistula rarely occurs in conjunction with an abscess after acute pancreatitis and treatment has not yet been established. This is an important case demonstrating that EUS-guided cyst drainage facilitates closure of such a fistula.
