A 27-Year-Old Man with Chronic Traumatic Pancreatic Fistula Managed with Percutaneous Microwave Ablation.

BACKGROUND Pancreatic fistulas are serious complications following abdominal trauma which are often overlooked and may lead to hemorrhage, sepsis, and abscess formation. Early diagnosis is critical, yet options are limited when the anatomy gets distorted secondary to a high impact collision. In the setting of trauma, delayed or missed ductal injuries can perpetuate collections and septic physiology despite drainage. Although commonly treated with endoscopic retrograde cholangiopancreatography (ERCP) or conservative measures, a complex case of pancreatic fistula seen in our clinic saw mainstream treatments continuously fail. This report describes the case of a 27-year-old man with chronic post-traumatic pancreatic fistula successfully managed with percutaneous microwave ablation. CASE REPORT A 27-year-old man sustained blunt abdominal trauma in a road traffic collision and developed a chronic pancreatic fistula. Despite multiple surgeries, conservative management with octreotide, total parenteral nutrition, and several unsuccessful attempts at ERCP, the fistula persisted, leading to recurrent sepsis and multi-organ failure. As a last resort, computed tomography (CT)-guided percutaneous microwave ablation of the pancreatic neck was performed. Multidisciplinary consensus favored targeted thermal occlusion to achieve source control while avoiding another high-risk laparotomy. The procedure resolved the fistula within 4 weeks. Drain output fell and the patient stabilized without further organ support. CONCLUSIONS This case demonstrates a novel use of percutaneous microwave ablation to treat a chronic traumatic pancreatic fistula, highlighting microwave ablation as a potential therapeutic option when conventional treatments fail. Also highlighted is the importance of early consideration of pancreatic fistula in cases of abdominal trauma.