Original title: Successful Endoscopic Treatment of Walled-Off Necrosis With Complex Quadruple Fistulas Among the Necrotic Cavity, Stomach, Duodenum, and Common Bile Duct
Shuhei Shibata, Yotaro Iino, Jo Kurosawa, Ken Uchida +6 · September 2026
Doctors treated a severe pancreatitis complication where dead tissue formed a walled-off pocket. To drain it, they placed a curved plastic stent tube, but it accidentally poked a hole through the patient's duodenum, the start of the small intestine. Abnormal tunnel connections, called fistulas, also formed between the stomach, the dead tissue space, the duodenum, and the bile duct. Doctors fixed the entire problem using only endoscopic tools, which are cameras and tiny instruments passed down the throat. They pulled out the stray plastic stent and stitched the stomach opening shut from the inside. The hole in the duodenum healed naturally on its own. Next, they repositioned a biliary stent correctly through the main bile duct opening. Without any open surgery, all the abnormal tunnels completely closed within 516 days.
Imagine a plumber trying to drain a flooded basement by inserting a pipe through the wall. Over time, that pipe rubs against the wall and creates a new hole into the neighbor's garage, then another into the sewer line, and another into the water main—four separate leaks where there should be none. Normally you'd have to tear open the walls to fix all the connections. In this paper the doctors used only tiny tools inserted through the original pipe hole to patch each leak from the inside, without ever cutting into the building.
This matters because patients with severe pancreatitis often develop walled-off necrosis that needs drainage. When complications like fistulas—abnormal connections between organs—arise, surgeons usually have to operate. This case shows that even four simultaneous fistulas can be fixed with endoscopy alone, avoiding major surgery and its long recovery.
This is a single case report, so the approach may not generalize to all patients with complex fistulas. The abstract does not describe the patient's long-term functional outcomes or quality of life after treatment. The success relied on specific anatomical conditions and may not be reproducible in patients with different fistula configurations or more extensive necrosis.
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Successful Endoscopic Treatment of Walled-Off Necrosis With Complex Quadruple Fistulas Among the Necrotic Cavity, Stomach, Duodenum, and Common Bile Duct — Shuhei Shibata, Yotaro Iino, Jo Kurosawa et al. — DEN open — doi:10.1002/deo2.70432
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.