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Pancreatico-Colonic Fistula after Endoscopic Ultrasound-Guided Cyst Drainage for Pancreatic Pseudocyst: Report of Three Cases

Shuhei Oana, Sho Shibata, Takayuki Matsumoto

Endoscopic ultrasound-guided cyst drainage is increasingly performed in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We have experienced three cases of colonic fistula after endoscopic ultrasound-guided cyst drainage. Case #1 was a patient with walled-off pancreatic necrosis, in which a fistula into the transverse colon occurred as a late complication of endoscopic ultrasound-guided cyst drainage. We closed the fistula with fibrin glue and endoscopic clips. Case #2 was a patient with walled-off pancreatic necrosis treated by endoscopic ultrasound-guided cyst drainage. During repeat endoscopic ultrasoundguided cyst drainage, a fistula was noted at the splenic flexure of the transverse colon, which was confirmed by contrast enema. He was successfully treated by diverting colostomy and abscess drainage. Case #3 was a patient with a history of pylorus-preserving pancreaticoduodenectomy for intraductal papillary-mucinous neoplasm. He presented with a pancreatic pseudocyst in the pancreatic tail. During endoscopic ultrasound-guided cyst drainage, a fistula was noted in the transverse colon. The patient was treated by naso-biliary tube with a pig-tail biliary stent and total parenteral nutrition. Our experience suggests that colonic fistula after endoscopic ultrasound-guided cyst drainagecan be managed conservatively.