GASTROCUTANEOUS FISTULA- A RARE COMPLICATION OF NECROTISING PANCREATITIS pawartejaswinim91@gmail.com

PE029

GASTROCUTANEOUS FISTULA- A RARE COMPLICATION OF NECROTISING PANCREATITIS

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India

Poster with Discussion

Necrotizing pancreatitis (NP) is a serious complication of acute pancreatitis which further complicated by the formation of gastrointestinal fistula. These fistulas are challenging and understudied compared to the colonic fistulas that are a more common complication of Necrotising pancreatitis.

74 year old female patient presented to our emergency department with complaints of abdomen pain, bloating and difficult in passing stools .She was evaluated for the same CECT abdomen and pelvis done - Features are suggestive of acute necrotizing pancreatitis (necrosis > 30%) with walled off necrosis, Modified CT severity index –10/10. Patient underwent laparoscopic necrosectomy following which she developed enterocutaneous fistulas . CECT abdomen with rectal contrast showed 1. Colonic fistula 2. Gastrocutaneous fistula.She was initially managed conservatively. In view of persistant high fistulous output , surgical intevention was adviced. She underwent Laparoscopic adhesiolysis + closure of gastric fistula + Gastrostomy + feeding jejunostomy + Ileostomy.

Gastrointestinal fistula was defined as a pathological connection of any part of the gastrointestinal tract (stomach, duodenum, jejunum, ileum and colon) to the pancreas and/or peripancreatic necrotic cavity. They occur in less that 4% of cases of necrotising pancreatitis.Risk factors involved ,low albumin levels , higher CT severity index and invasive intervention prior to diagnosis of gastrointestinal fistula. Early enteral nutrition was considered as a protective factor

Improved nutrition and a high degree of suspicion and early detection of gastrointestinal fistulas may be life saving in a patient with severe Necrotising pancreatitis