Pancreaticoenteric fistula: no longer a surgical disease?

We report our experience with eight patients with severe persistent pancreatitis associated with peripancreatic fluid collections requiring placement of drainage catheters who subsequently developed pancreatic fistula. The fistulas were diagnosed by endoscopic retrograde cholangiopancreatography, contrast tube study, or Hypaque enema at a mean of 13 weeks after diagnosis of pancreatitis and drain placement. These fistulas involved the duodenum in five patients and colon in three patients. Six patients had fistula resolution with medical therapy (after removal of percutaneous drainage catheters in three and with drain removal in conjunction with transpapillary stenting of a disrupted pancreatic duct in another three). We conclude that in patients with ongoing pancreatitis, pancreaticoenteric fistulas are probably caused by erosion of percutaneous drainage catheters. Such fistulas resolved with conservative treatment in six of eight patients.