A rare postoperative complication after a step-up approach for walled-off pancreatic necrosis: locating a difficult digestive duct fistula.

We present a case of a gallbladder-abscess cavity fistula in a 46-year-old male with walled-off pancreatic necrosis (WOPN). After receiving the step-up approach for 2 months, which consisted of minimally invasive necrosectomy followed by postoperative percutaneous lavages with two drainage tubes, the range of abscess was significantly reduced, as shown by computerized tomography scanning (Fig. 1). However, a substantial amount of odorless, pale yellow, feculent fluid (almost 1000mL daily) was discharged from the drainage tubes in the following days without lavages, which could have been ascribed to a bile leak. After repeatedly adjusting the position of the drainage tubes in the abscess cavity and keeping the patient in a supine position, the abnormal gallbladder fistula connected to WOPN was located through retrograde X-ray screening (Fig. 2A, B and C). After percutaneous transhepatic gallbladder drainage, the patient was later discharged. PMID: 33228370 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research