SPONTANEOUS HEALING OF PANCREATIC-ABSCESS AFTER FISTULIZATION TO THE DUODENAL BULB

A 70-year-old man was admitted to the hospital because of sudden, uppe r abdominal and back pain. Laboratory and image data indicated acute p ancreatitis, Shortly after the admission, pancreatic and liver abscess with bacteremia developed. Antibiotic therapy seemed effective. A mon th later, spontaneous fistulization of the pancreatic abscess to the d uodenal bulb was found by gastroduodenal fiberscopy. Injection of cont rast medium into the duodenal orifice showed that the fistula was drai ning the abscess and that no other fistula formed from the abscess. En doscopic retrograde cholangiopancreatogram indicated no fistula format ion to the pancreatic duct. The pancreatic abscess became smaller and was not visible using computerized tomography and ultrasonography 3 mo nths later and thereafter. Closure of the duodenal orifice was ascerta ined by the endoscopy. It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic du odenal bulb, which is not supposed to allow most bacterial growth. Pan creatic abscess usually necessitates operative treatment, even with fi stulization to the alimentary tract. It seems likely that the single, small fistulization to the bulb, in addition to the lack of underlying disease and medical and nutritional support, facilitated the spontane ous healing process.