A 64-year-old man was admitted with acute pancreatitis. On the 29th day of hospitalization, an abdominal computed tomography (CT) scan revealed infected walled-off necrosis, prompting endoscopic ultrasound-guided drainage through the stomach.
Subsequently, multiple necrosectomies were performed using both endoscopic and percutaneous drainage as part of a step-up approach. Nine months after the onset of pancreatitis, contrast imaging was performed via an external fistula in the right lower abdomen to evaluate the fistula and attempt closure with endoscopic clipping. However, 10 days after clipping, contrast leakage into the duodenum was observed again when fluid passed through the external fistula. The fistula was then successfully ligated using an over-the-scope clip (OTSC) with the suction method. Following OTSC placement, the fistula was effectively sealed, and the right lower abdominal abscess showed significant improvement.
