Surgical treatment of this complication is accompanied by a high mortality rate. Endoscopic or radiographic

interventions are preferable. Methods: We described a case in which a fistula on descending colon, due to necrotizing pancreatitis, was effectively treated using the over-the-scope Doxorubicin price clip system (OTSC – system; Ovesco Endoscopy AG, Tubingen – Germany). Results: A 76-years old woman patient, with a known history of gallstones, hospitalized for acute abdominal pains, vomiting, fever and jaundice. Laboratory tests showed severe anaemia, leukocytosis and elevated levels of liver and pancreatic enzymes, VES and

CRP. The patient was subjected an emergency laparotomy. Surgical exploration revealed a pattern of exudative-necrotizing pancreatitis associated with diffuse peritonitis and an abundant abdominal and pleural effusion. The hydropic gallbladder contained multiple stones and the intraoperative cholangiography exluded the presence of stones or abnormality in the bile ducts. At first, a cholecystectomy was performed and trans-cystic drainage was inserted and then, an accurate toilette of peritoneal cavity was maked. Multiple drainages were placed in the pancreatic area with necrotic/purulent and blood materials to leak out, for some days. Even 上海皓元 so, on the EPZ015666 15th post-operative day, a great peri-pancreatic infected collection, extended to spleen lodge, developed. Furthermore, during second look, further drainages were placed and many daily washes were performed. Subsequently,

a next radiologic examination discovered a fistula involving the peri-pancreatic abscess and descending colon. Therefore, the patient was transferred to our Unit of Gastroenterology and Digestive Endoscopy, in steady-state conditions and contrast-enhanced TC was performed. The drained fluid through the percutaneous drainage showed the communication with descending colon. A lower gastrointestinal endoscopy confirmed the presence of the retroperitoneocolonic fistula. After administration of methylene blue, the drained fluid showed blue staining in the anterior abdominal wall and the communication with colon. An attempt to seal the perforation endoscopically was performed using the OTSC system and the lesion was closed with one clip. The fistula showed a good healing such as reported by subsequent radiologic examinations. The drainages were removed gradually and the patient was discharged in some weeks later.