Coiling by ERCP and percutaneous NBCA embolization are useful for treatment of a postoperative pancreatic fistula

Abstract

A 46-year-old man underwent high anterior resection and splenectomy for rectal cancer and idiopathic thrombocytopenic purpura, respectively. However, a postoperative pancreatic fistula developed. Although the patient's condition improved with pancreatic duct stenting, recurrence of the pancreatic fistula and intra-abdominal abscesses were later noted. Conventional treatment was expected to be refractory, considering the endoscopic retrograde pancreatography findings and coil embolization was performed, with placement of a transpapillary pancreatic duct stent. Furthermore, percutaneous infusions of n-butyl-cyanoacrylate were administered, and was applied to sandwich the pancreatic fistula upstream and downstream. Pancreatitis was observed afterward and was relieved with non-operative management. The rectal cancer subsequently recurred, and recurrence of the pancreatic fistula was suspected, necessitating operative intervention. We report that these procedures may be adopted as treatment for refractory pancreatic fistulas.