Korean J Gastroenterol.  2020 May;75(5):305-307. 10.4166/kjg.2020.75.5.305.

Gastric Fistula Formation of Infected Pancreatic Walled-off Necrosis after Percutaneous Drainage, followed by Migration of Pigtail-catheter into Gastric Lumen

• Park Ty
• Kang H

• KMID: 2504251
• DOI: http://doi.org/10.4166/kjg.2020.75.5.305

Figure

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  Fig. 1 Studies on the initial presentation. (A) Abdominal computed tomography showing large multiloculated gas-containing cystic lesions with rim enhancement, suggesting infected walled-off pancreatic necrosis. (B) Endoscopy showing mucosal edema, rugal hypertrophy, and extrinsic indentation at the posterior wall of the gastric upper body.

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  Fig. 2 Gastric fistula formation. (A) Fluoroscopy showing contrast outflow from pancreatic walled-off necrosis through a fistulous tract (white arrow) to the stomach. (B, C) Endoscopy showing a fistula opening covered with exudate and blood clots at the top of the extrinsic indentation at the posterior wall of the upper stomach body.

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  Fig. 3 Intragastric migration of percutaneous drainage catheter. (A) Endoscopy showing the pig-tail catheter penetrating the stomach. (B) A closer look at the penetrated fistula opening at the posterior wall of the upper body showing a clear margin and pus-like discharge. (C, D) Abdominal computed tomography showing a migrated drainage catheter (white arrow), and nearly resolved walled-off necrosis around the pancreas tail.

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  Fig. 4 Upper gastrointestinal series with Gastrografin after removing the percutaneous drainage catheter showing extragastric contrast outflow (white arrow), but no contrast dissemination into the peritoneal cavity.

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