Pancreatic pseudocystocolonic fistula treated without surgical or endoscopic intervention

Figure 1 Fatty infiltration and fluid accumulation around the peripancreatic area observed by computerized tomography. Computerized tomography scans taken upon the patient’s admission to the hospital. A: Axial view; B: Coronal view.

Figure 2 A fistula and a pseudocyst identified through computerized tomography. A: There was a fistula in the right side of the colon (yellow circle); B: There was a pseudocyst approximately 9.3 cm long (demarcated by double-headed arrow) that contained air.

Figure 3 Fistula opening identified by colonoscopy. There was a fistular opening (arrow) that surrounded edematous and hyperemic mucosa at the hepatic flexure.

Figure 4 Timetable of bowel cleansing, administration of antibiotics and nutrition. After daily bowel cleansing using a polyethylene glycol solution, white blood cell (WBC) count and C-reactive protein (CRP) value were decreased. After the initial bowel cleanse was stopped, we observed an elevated WBC count and CRP level. The bowel cleanse was continued until 6 wk after admission. Adm: Admission; NPO: Nil per os; TPN: Total parenteral nutrition.