Successful endoscopic closure of an esophagobronchial fistula as a result of a pancreatic pseudocyst with the over‐the‐scope clip system and endoscopic nasopancreatic drainage

Pancreatic pseudocyst-portal vein (PP-PV) fistula, mostly occurring after pseudocyst formation following acute/chronic pancreatitis, is a rare but life-threatening condition. The majority of treatments are based on conservative or surgical interventions. We report the case of a 70-year-old man with a PP-PV fistula and PV thrombosis. We adopted conservative treatment at first due to his mild symptoms. However, after resuming food intake, the patient had severe abdominal pain. Following endoscopic retrograde cholangiopancreatography, we found that the pseudocyst was connected with the PV through the fistula. Subsequently, an endoscopic nasopancreatic drainage (ENPD) catheter was inserted into the main pancreatic duct to establish pancreatic drainage, which resulted in a decrease in the abdominal pain. After the ENPD tube had been exchanged for endoscopic pancreatic stenting, his abdominal pain did not recur. Therefore, this case demonstrated endoscopic treatment as an effective treatment option for PP-PV fistula.

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Successful combination strategy of preoperative placement of an endoscopic nasopancreatic drainage catheter and pancreas preservation surgery for pancreatic injury with major pancreatic duct disruption: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0743-1 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Kenji Kandori ◽

Wataru Ishii ◽

Ryoji Iizuka

Keyword(s):

Pancreatic Duct ◽

Pancreatic Resection ◽

Pancreatic Injury ◽

Combination Strategy ◽

Pancreatic Body ◽

First Case ◽

Endoscopic Nasopancreatic Drainage ◽

Pancreas Preservation ◽

Nasopancreatic Drainage ◽

Grade Iii

Abstract Background The guidelines recommend pancreatic resection for grade III and IV pancreatic injuries. On the other hand, organ preservation is an important issue. Herein, we present the first case of pancreatic injury with major pancreatic duct (MPD) disruption that was treated with the combination of preoperative placement of endoscopic nasopancreatic drainage (ENPD) catheter and pancreas preservation surgery after endoscopic pancreatic stenting (EPS) failure. Case presentation A 70-year-old female diagnosed with pancreatic injury was admitted to our hospital. She was hemodynamically stable. ERP revealed MPD disruption, and EPS failed. An ENPD catheter was placed preoperatively at the site of injury. During laparotomy, we identified a partial-thickness laceration in the pancreatic body. At the site of injury, the tip of the ENPD catheter was found; therefore, the patient was diagnosed with grade III pancreatic body injury with MPD disruption. The extent of crush was not severe, and we had no difficulty in identifying the distal MPD segment. We inserted the ENPD catheter into the distal MPD segment. The ruptured MPD and the laceration was sutured, then pancreatic resection was prevented. She was discharged on POD 56. Conclusion The treatment strategy incorporated ERP, placement of an ENPD catheter preoperatively, and a simple surgery in a hemodynamically stable patient with pancreatic injury allows the pancreas and spleen to be preserved.

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Endoscopic closure of spontaneous idiopathic esophagobronchial fistula

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.05.026 ◽

2016 ◽

Vol 84 (5) ◽

pp. 847-848

Author(s):

Marcel Tanţău ◽

Ioana Vişovan ◽

Cristian Tefas

Keyword(s):

Esophagobronchial Fistula ◽

Endoscopic Closure

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Pancreatic trauma: proposal for management algorithm

International Surgery ◽

10.9738/intsurg-d-20-00015.1 ◽

2020 ◽

Author(s):

Daisuke Hashimoto ◽

Tomohisa Yamamoto ◽

So Yamaki ◽

Kazuhito Sakuramoto ◽

Rintaro Yui ◽

...

Keyword(s):

Interventional Radiology ◽

Mortality Rate ◽

Pancreatic Duct ◽

Conservative Management ◽

Main Pancreatic Duct ◽

Surgical Techniques ◽

Postoperative Mortality ◽

Pancreatic Trauma ◽

Endoscopic Nasopancreatic Drainage ◽

Nasopancreatic Drainage

IntroductionPancreatic trauma is potentially lethal despite recent improvements in surgical techniques and conservative management. However, no guidelines for the management of pancreatic trauma have been established. In this report, we propose an algorithm for the management of pancreatic trauma based on our experience of nine cases and a literature review.Case presentationThis study included nine patients with pancreatic trauma (five men and four women). The patients’ median age was 40 years (range, 17–75 years). The overall mortality rate was 22.2%, and the postoperative mortality rate was 16.7%. Superficial trauma was present in two patients. Deep trauma without injury to the main pancreatic duct was present in one patient, and this patient was treated successfully with endoscopic nasopancreatic drainage. Active bleeding was present in two patients and controlled by interventional radiology. Deep trauma with injury to the main pancreatic duct was present in six patients. Among them, one patient died after conservative treatment with endoscopic nasopancreatic drainage. The other five patients underwent surgery (pancreatic resection in four and necrosectomy in one).ConclusionThe herein-described algorithm recommends interventional radiology for active arterial bleeding, conservative management for trauma without ductal injury, and surgery for trauma with ductal injury. This algorithm may provide a basis for future establishment of guidelines.

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