Transmural Endoscopic Necrosectomy through a Spontaneous Gastric-pan-creatic Fistula Secondary to Infected Encapsulated Necrosis

García J.R.; Vargas-Alayza C.; Ravelo N. · Acta Gastroenterologica Latinoamericana (2023) · DOI: 10.52787/agl.v53i1.261

Resumen

The Atlanta classification makes an important distinction between collections composed only of fluid and those con-taining necrosis. In the last group, encapsulated or walled necrosis refers to an encapsulated collection of pancreatic and/or peripancreatic necrosis that presents a well-defined wall. When it is asymptomatic, the treatment is conservative; when it is infected it requires drainage. Spontaneous rupture of encapsulated necrosis into the gastrointestinal tract is a rare event. We present the case of a patient with upper gastrointestinal bleeding secondary to a gastric-pancreatic fis-tula caused by an infected encapsulated pancreatic necrosis. Days after the upper endoscopy was performed due to bleed-ing, an increase in the diameter of the fistula was observed, through which the endoscopic necrosectomy was successfully performed, achieving that the patient improved remarkably after the second session.