Post written by Erica Park, MD, from the Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

We describe a case of biliary obstruction from a walled-off pancreatic necrosis, for which the patient underwent EUS-guided cystduodenostomy for biliary decompression. The patient’s liver function tests results subsequently improved, which we initially believed was because of cystduodenostomy.

However, during direct endoscopic necrosectomy, a biliary fistula into the necrotic cavity was discovered. The cavity also had fistulized into the second portion of the duodenum. A fully covered metal stent was placed into the common bile duct, helping resolve the biliary fistula. Follow-up endoscopy revealed resolution of the biliary fistula and duodenal fistula.

This video highlights many adverse events that may occur from a walled-off pancreatic necrosis. Although they are rare, it is important to recognize potential adverse events of a walled-off pancreatic necrosis, and this video provides a practical treatment.

Fistulization of the cavity to the second portion of the duodenum (white arrow), with biliary fistula within the collection (black arrow).

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