Introduction Pancreatitis can be associated with walled off necrosis and fistula resulting in significant morbidity and mortality. We present a case of a patient without previous history of abdominal pain or acute pancreatitis who, while being investigated with respiratory symptoms, was diagnosed with lung cancer and was found to have a Pancreatico-colonic fistula. The aim of the study was to perform a systematic review on pancreatico-colonic fistula and assess if conservative management can be possible in specific situations. Material and Methods Available literature in English was reviewed until January 2019. PRISMA guidelines were followed identifying 91 records. After screening, seven papers reporting seven patients were identified as definitive pancreatico-colonic fistula and included. All of these were case-reports. Results-Case report A sixty-seven-year-old man with smoking history and strong alcohol intake presented with weight loss and non-productive cough. There was no prior history of pancreatitis or significant abdominal pain. A chest x-ray, showed a left upper lobe pulmonary lesion. Computed tomography demonstrated an abnormal pancreas with intra-panrenchymal gas along body and tail tracking back towards the transverse colon. A gastrografin enema showed pancreatic duct filled with contrast retrogradely through the transverse colon. As he was asymptomatic from the pancreatic standpoint a conservative approach was adopted. Literature review Eight cases (including the authors`) were identified, 3 were incidental, 3 were following recurrent pancreatitis and 2 were diagnosed after laparotomy. Our case appears to be the first that presented without a prior history of acute pancreatitis. Treatment was conservative in 3, endoscopy in 3 and surgical in 2 cases. Resolving fistula in follow up occurred in 6 and all patients were alive at the time of the publications. Discussion Pancreatico-colonic fistula is rare and potentially fatal complications. Our case is unique as the patient presented with no prior history of pancreatitis. As in our case, a conservative, non-operative course is appropriate in selected patients.
Mar Achalandabaso Boira, Luis Ferreira, Caroline Conlon, Caroline Conlon
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