2018 Volume 33 Issue 6 Pages 949-956
A 72 year-old man, with a history of a pancreatic pseudocyst with previous hemorrhage, underwent endoscopic mucosal resection of descending colon polyps. He developed a persistent high fever in the evening after resection. Two days after resection, he presented with fever and fatigue. Blood tests showed an elevated white blood cell count, and contrast-enhanced computed tomography scan showed increased pancreatic cysts. He was admitted for treatment of the pancreatic pseudocyst. A high-level inflammatory reaction persisted despite non-operative treatment, and a fistula to the digestive tract was suspected on the basis of CT imaging. A colonoscopy was performed, and a 5mm opening was found in the descending colon. Injection of contrast medium confirmed a fistula to the pancreatic cyst. The pancreatic pseudocyst-descending colon fistula was closed by endoscopic clip placement. There are previous reports of rupture in the abdominal cavity with penetration into the gastrointestinal tract as a complication of a pancreatic pseudocyst, This was a much rarer case of pancreatic pseudocysts-gastrointestinal fistula caused by therapeutic colonoscopy.
