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Korean J Gastroenterol  <  Volume 73(6); 2019 <  Articles

Korean J Gastroenterol 2019; 73(6): 365-369  https://doi.org/10.4166/kjg.2019.73.6.365
Feasibility of Adopting the “Step-up Approach” in Managing Necrotizing Pancreatitis-induced Pancreatic-colonic Fistula
Sung Kyun Yim, Seong Hun Kim, Seung Young Seo, Hee Chan Yang and Seung Ok Lee
Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
Correspondence to: Seung Ok Lee, Division of Gastroenterology, Department of Internal Medicine, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. Tel: +82-63-250-1289, Fax: +82-63-254-1609, E-mail: solee@jbnu.ac.kr, ORCID: https://orcid.org/0000-0003-0243-215X
Received: January 1, 2019; Revised: February 18, 2019; Accepted: March 10, 2019; Published online: June 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Managing acute pancreatitis is clinically challenging because of the generally poor patient condition, the variety of treatment options depending on the severity and complications, and the uncertainty of outcomes. Recently, the step-up approach, which involves less invasive initial treatment and more invasive subsequent treatment, where necessary, has been proposed as the mainstay of managing pancreatitis. This paper presents a case of a 57-year-old man with severe acute pancreatitis, who developed an unexpected fistula in the rectum, which was treated successfully using the step-up approach. In managing this case, the authors faced clinical challenges in determining the infection of necrotic tissue in the early phase of the disease, the optimal timing and method of drainage, and the fistula closure or repair technique. Successful management of this case using the step-up approach validated current recommendations and suggests that it is a reasonable treatment strategy for pancreatic-colonic fistulas. This case also highlights the importance of an awareness that pancreatitis-associated complications can develop in an unexpected manner.
Keywords: Pancreatitis, acute necrotizing; Colon; Rectum; Fistula


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