Špička Petr, Vaněk Petr, Chudáček Josef, Falt Přemysl, Hruška František, Řezáč Tomáš, Ambrož Radek, Molnár Ján, Zbořil Pavel, Vrba Radek, Klos Dušan
Department of Surgery I, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.
Department of Internal Medicine II - Gastroenterology and Geriatrics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.
AME Case Rep. 2024 Jul 18;8:90. doi: 10.21037/acr-24-18. eCollection 2024.
This study highlights an unusual and previously unreported adverse event (AE) following the minimally invasive treatment of pancreatic walled-off necrosis (WON). The standard treatment for WON currently involves primary drainage via an ultrasound-guided endoscopic, typically transgastric, approach. This method is associated with lower mortality and morbidity rates compared to traditional surgery. However, emerging AEs from these procedures may necessitate the involvement of a multidisciplinary team. Our case highlights the potential for gastrovesical fistula development as a rare AE following endoscopic drainage. Treatment for our patient prioritized individualized and non-surgical strategy, although surgical revision was also considered.
A 42-year-old male presented with a large symptomatic pancreatic WON refractory to conservative management, necessitating transgastric drainage. Despite the gradual evacuation of the WON contents, treatment was complicated by stent-related issues, including inadvertent bladder penetration. Rather than surgical correction, a collaborative approach among urology, gastroenterology, and surgery teams was employed, focusing on conservative treatment strategies. This approach successfully resolved the fistula, leading to the patient's full recovery.
Given the increasing use of endoscopic transluminal drainage in (peri)pancreatic collections, it is crucial to be aware of all potential AEs. To our knowledge, this is the first documented case of gastrovesical fistula following drainage of WON. Early recognition and a multidisciplinary approach are vital to manage this event.
本研究强调了在胰腺壁性坏死（WON）微创治疗后出现的一种罕见且此前未报道过的不良事件（AE）。目前WON的标准治疗方法是通过超声引导下的内镜，通常是经胃途径进行初次引流。与传统手术相比，这种方法的死亡率和发病率较低。然而，这些手术中出现的新的不良事件可能需要多学科团队的参与。我们的病例突出了内镜引流后罕见的不良事件——胃膀胱瘘形成的可能性。尽管也考虑了手术修复，但对我们患者的治疗优先采用个体化的非手术策略。
一名42岁男性因保守治疗无效的有症状的巨大胰腺WON前来就诊，需要进行经胃引流。尽管WON内容物逐渐排出，但治疗因支架相关问题而复杂化，包括意外穿透膀胱。泌尿外科、胃肠病科和外科团队采用了一种协作方法，而不是手术矫正，重点是保守治疗策略。这种方法成功解决了瘘管问题，使患者完全康复。
鉴于内镜下经腔引流在（胰周）胰腺积液中的应用日益增加，了解所有潜在的不良事件至关重要。据我们所知，这是首例记录在案的WON引流后发生胃膀胱瘘的病例。早期识别和多学科方法对于处理这一事件至关重要。
