ENDOSCOPIC OCCLUSION WITH FIBRIN GLUE OF A PANCREATIC FISTULA AFTER ACUTE-PANCREATITIS

History and clinical findings: A 45-year-old patient was admitted beca use of frequent attacks of upper abdominal pain after food intake. The pain episodes had started shortly after a bout of acute pancreatitis. Physical examination was unremarkable except for mild pain on palpati on of the left lower abdomen. Investigations: Amylase and gamma-glutam yl transaminase activities as well as inflammatory parameters were sli ghtly raised. Ultrasonography was suggestive of a circumscribed area o f necrosis in the tail of the pancreas, a finding confirmed on endosco pic retrograde injection of contrast medium, which passed into the nec rotic cavity via a fistula. Treatment and course: The fistula failed t o close during 12 days of conservative treatment (total parenteral nut rition; 2 g ceftizoxim twice daily; 1 ampoule somatostatin daily). in three sittings during 6 days, 1-2 ml fibrin glue injections were made by endoscopy retrogradely into the fistular passage resulting in its c omplete occlusion without any further complications. Conclusion: A pre viously treatment-resistant pancreatic fistula can be successfully occ luded by injection of fibrin glue by retrograde endoscopy, obviating s urgical intervention with subsequent reduction in glandular capacity.