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The formation of gastrointestinal fistulas has been reported as a rare complication associated with late-stage, severe, acute pancreatitis. This condition is difficult to treat and often requires surgery [1]. Here we report on a successful case of endoscopically implanted polyglycolic acid (PGA) sheets (Neoveil; Gunze Co., Tokyo, Japan) being used to repair a fistula that had formed between the colon and skin. A 60-year-old man had been hospitalized for alcohol-related severe acute pancreatitis. Because he suffered from extensive walled-off necrosis, we performed necrosectomy and colostomy with double orifices in the transverse colon. Owing to the complications of acute respiratory distress syndrome and acute renal failure, the patient was observed for 2 months in the intensive care unit, after which hewas transferred to the general ward. Contrast imaging performed by introducing a contrast medium through the abdominal drain revealed a colocutaneous fistula (●" Fig.1). Endoscopic examination indicated ulceration and stenosis of the splenic flexure along with a fistula (●" Fig.2). Follow-up examination was performed a month later, and results indicated that the fistula had not closed. We then decided to perform endoscopic insertion of PGA sheets into the fistula. An endoscope was inserted through the colostomy and maneuvered to the fistula. The forceps grasping the PGA sheet was inserted through the endoscope. The PGA sheet extending from the end of the endoscopewas grasped by another forceps that was inserted through the fistula and then pulled up toward the skin. This procedure was repeated three times to fill the fistula with several PGA sheets. An endoscopic sprinkler was then used to apply a fibrin sealant (Beriplast P Combi-Set Tissue adhesion; CSL Behring, Tokyo, Japan) and complete the procedure (●" Video 1). Endoscopic images taken 3 weeks after the procedure showed that the fistula had been covered by granulation tissue and had completely closed (●" Fig.3). The Fig.1 Contrast imaging performed by introducing a contrast medium through the abdominal drain revealed a colocutaneous fistula (arrow). Fig.2 Endoscopic images. a Endoscopy confirmed stenosis and ulceration of the splenic flexure. b The fistula was in the center of the ulcer.

Novel endoscopic treatment for colocutaneous fistula after severe acute pancreatitis: filling with a polyglycolic acid sheet