Endoscopic occlusion with fibrin glue of a pancreatic fistula after acute pancreatitis

History and clinical findings: A 45-year-old patient was admitted because of frequent attacks of upper abdominal pain after food intake. The pain episodes had started shortly after a bout of acute pancreatitis. Physical examination was unremarkable except for mild pain on palpation of the left lower abdomen. Investigations: Amylase and gamma-glutamyl transaminase activities as well as inflammatory parameters were slightly raised. Ultrasonography was suggestive of a circumscribed area of necrosis in the tail of the pancreas, a finding confirmed on endoscopic retrograde injection of contrast medium, which passed into the necrotic cavity via a fistula. Treatment and course: The fistula failed to close during 12 days of conservative treatment (total parenteral nutrition; 2 g ceftizoxim twice daily; 1 ampoule somatostatin daily). in three sittings during 6 days, 1-2 ml fibrin glue injections were made by endoscopy retrogradely into the fistular passage resulting in its complete occlusion without any further complications. Conclusion: A previously treatment-resistant pancreatic fistula can be successfully occluded by injection of fibrin glue by retrograde endoscopy, obviating surgical intervention with subsequent reduction in glandular capacity.