Aim:WOPN is complication of acute necrotising pancreatitis.Infected WOPN with air within require immediate drainage.We present a case series of patients presenting with bowel fistula and were managed endoscopically
Materials and Methods:
9patients were studies from September 2022 to September 2024 in a single center study.all patient had underwent prior CECT abdomen for WOPN anatomy and were on follow-up as they had significant solid component.Repeat CECT abdomen was done at the onset of symptoms.patients underwent upper GI endoscopy or colonoscopy or both for fistula identification.Necrosectomy was performed as and when it was warranted.All procedures were done under short general anaesthesia and under CO2 insufflation.All patients were followed up every month for 6 months to 2years.
Results:
All 9 patients were males with age ranging from 26 to 58years.The duration of follow up from primary CECt to onset of symptoms ranged from 20 days to 3 months. WOPN were peripancreatic in 6 patients and peripancreatic and perinephric in 3 patients. Common symptoms patients presented with were abdominal pain in 9 patients,fever in 5 patients,black stools in 5 patients and vomitting in 4 patients.4 patients had a fistulous opening at 1st part of duodenum, one had fistula at 3rd part of duodenum,one in transverse colon and 3 patients in descending colon.4 patients required one session of Necrosectomy (2 patients with D1 fistula and 2 patients with descending colon fistula). All the WOPN were drained with 7 French or 10 French double pigtail stents.None of the patients had any complications related to the procedure. Complete recovery of WOPN was seen in all the patients.follow up duration ranged from 6 months to 2 years.none of the patient required addition percutaneous or surgical intervention.
Conclusion:
Infected WOPN with air in WOPN is a rare complication.Actively looking for a fistulous opening helps in diagnosis. WOPN drainage and sos Necrosectomy through the fistulous opening gives excellent results and reduces the morbidities and mortality associated with aggressive surgical or percutaneous approaches.