Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1882
Revised: December 9, 2013
Accepted: December 12, 2013
Published online: February 21, 2014
We report here a case of pancreatic pseudocystocolic fistula that was treated without surgical or endoscopic intervention. A 76-year-old woman, presenting with a fever and epigastric pain, was referred to our institution. Three months prior to this admission, the patient had been admitted to the hospital for acute pancreatitis. Abdominal computerized tomography (CT) revealed a 9 cm pseudocyst containing air, and a fistular opening was observed via colonoscopy. After colonoscopy, the abdominal pain was slightly improved, the fever subsided and laboratory results showed decreased C-reactive protein levels. The observed improvement was likely due to the cleansing of the bowel, which induced spontaneous drainage from the pseudocyst into the colon. Antibiotic therapy was administered and daily bowel cleansing was performed using a polyethylene glycol solution. After three weeks, a follow-up CT revealed that the size of the pseudocyst had decreased significantly from 9 to 5.3 cm. In addition, laboratory tests were improved. The patient was able to resume a normal diet and was discharged in good overall health from the hospital, without aggravation of the symptoms. A colonoscopy performed 3 mo later and a follow-up CT performed 6 mo later confirmed that both the fistula and pseudocyst had completely disappeared.
Core tip: We present the case of a 76-year-old female who was admitted to our institution with epigastric pain and a fever. Abdominal computed tomography and colonoscopy revealed a pseudocystocolic fistula. The patient was treated with antibiotics and bowel cleansing was administered using a polyethylene glycol solution. Induction of spontaneous drainage into the colon, through bowel cleansing, can treat small pseudocystocolic fistulas.