A Case of Pancreaticocutaneous Fistula Treated by Negative Pressure Wound Therapy

Abstract

A 68-year-old man who had been receiving treatment for viral hepatitis type C was pointed out having a tumor in the pancreas head. It was finally diagnosed as pancreatic abscess. Since he also developed hepatic abscess as well as recurrent pancreatic abscess, he was referred to our hospital. When 2 months had passed after his first visit, pancreatic leakage associated with purulent discharge erupted at the middle part of a surgical scar of a surgery for duodenal ulcer and was complicated with dermatitis around the crater. He was emergently admitted to our hospital due to massive leakage. A CT scan confirmed the fistula was connected with the pancreas head, and the amylase level of the discharge was as high as 47360 IU/dl. It was diagnosed with pancreaticocutaneous fistula. Despite gauze protection his dermatitis became worse, so somatostatin analogue administration was started on the 2^nd hospital day, but it was withdrawn on the 6^th hospital day due to adverse side effect. Continuous drainage of discharge was thought to be necessary, and on the 9^th hospital day, negative pressure wound therapy (NPWT) was started. His dermatitis rapidly subsided, and in 4 weeks, pancreaticocutaneous fistula was cured. One month later, recurrence was seen, but was cured with one-week NPWT. Thereafter no recurrence has occurred. For pancreaticocutaneous fistula NPWT would be one of an options of treatment.