INTRODUCTION

Pancreatic fistula is a common complication following pancreatic surgery, occurring in up to 27% of cases. It consists of an abnormal communication between the pancreatic duct and another anatomical space, resulting in leakage of enzyme-rich pancreatic fluid. Diagnosis is established by abdominal CT scan, and management typically includes antibiotic therapy, endoscopic or percutaneous drainage, and, if necessary, surgical intervention.

We present the case of a 65-year-old man who had recently undergone distal pancreatectomy with splenectomy for pancreatic adenocarcinoma and was admitted with septic shock. CT imaging revealed multiple collections in the splenectomy and pancreatic tail region. Several surgical drains were placed without success, as the collections persisted after a few days. A high-output pancreatic fistula was suspected, and an Endoscopic Retrograde Cholangiopancreatography (ERCP) was requested to facilitate drainage of the collections.

ENDOSCOPY

During ERCP, selective cannulation of the Wirsung duct was achieved using a reverse double-guidewire technique. The duct appeared shortened (5–6 cm) and displaced as a result of the prior surgery. Contrast injection demonstrated leakage from the remnant of the Wirsung duct and its branches, likely communicating with the described collections. A 5 cm × 5 Fr plastic pancreatic stent was placed, with abundant pancreatic juice observed flowing through the papilla. A follow-up CT scan one week later showed a marked reduction in the size of the surgical bed collections, with the stent in good position and no ductal dilatation.

The patient remains stable, showing good clinical progress, pending complete resolution of the collections.

CONCLUSION

Endoscopic drainage of collections secondary to pancreatic leaks via ERCP may represent an effective therapeutic option, potentially reducing the need for repeat surgical interventions.