[Transmural Endoscopic Necrosectomy through a Spontaneous Gastric-pancreatic Fistula Secondary to Infected...

The Atlanta classification makes an important distinction between collections composed only of fluid and those containing necrosis. In the last group, encapsulated or walled necrosis refers to an encapsulated collection of pancreatic and/or peripancreatic necrosis that presents a well-defined wall. When it is asymptomatic, the treatment is conservative; when it is infected it requires drainage. Spontaneous rupture of encapsulated necrosis into the gastrointestinal tract is a rare event. We present the case of a patient with upper gastrointestinal bleeding secondary to a gastric-pancreatic fistula caused by an infected encapsulated pancreatic necrosis. Days after the upper endoscopy was performed due to bleeding, an increase in the diameter of the fistula was observed, through which the endoscopic necrosectomy was successfully performed, achieving that the patient improved remarkably after the second session.