Pancreatico-cutaneous fistula following complicated perforated peptic duodenal ulcer repair.

Pancreatic fistulas are a known complication following gastrointestinal surgeries, especially when there is disruption to pancreatic tissue or ducts. These fistulas occur due to leakage of pancreatic enzymes, which can lead to inflammation, infection, and other complications. While typically associated with pancreatic resections, fistulas can develop when the ulcer involves the pancreas leading to pancreatic ductal disruption. A 59-year-old female presented with hyperacute epigastric pain, hematemesis, septic shock with a blood pressure of 89/62, a Boey score of 3, and a Pulp score of 4. Imaging revealed a perforated duodenal ulcer with signs of peritonitis and based off the WSES guidelines for the management of Perforated Bleeding Ulcers published in 2020, she underwent exploratory laparotomy with ulcer repair. Postoperatively, she developed a pancreaticocutaneous fistula, confirmed by elevated amylase in the wound drainage. She was managed conservatively with percutaneous drainage and the placement of a pancreatic stent, leading to gradual resolution of the fistula. Management of pancreatic fistulas focuses on early diagnosis and intervention to prevent complications such as abscess formation or sepsis. Endoscopic stenting helps relieve pressure on the pancreatic duct and promotes fistula closure. Nutritional support, including pancreatic enzyme replacement therapy, may be necessary for patients with impaired pancreatic function to aid in digestion and reduce pancreatic strain. Most pancreatic fistulas can be managed conservatively without surgery if identified early, combining drainage, endoscopic stent and sphincterotomy, and nutritional support. Early intervention improves outcomes and reduces the risk of additional complications.