TTP5.06 The spontaneous formation of a pancreatico-cutaneous fistula via the inguinal canal secondary to necrotising pancreatitis

Introduction Necrotic pancreatitis can be complicated by the formation of both pancreatic and peri-pancreatic collections. Whilst these usually remain within the retroperitoneum, they may, in rare cases, communicate with other anatomical sites. Case Report We present a case of a 68-year-old male with CT-proven persistent necrotizing pancreatitis complicated by a multi-loculated complex peri-pancreatic collection. 7 months following initial diagnosis, the patient re-presented with a discharging right groin sinus. Imaging revealed progression of the collection and communication with the right inguinal canal, resulting in percutaneous fistulation in the right groin, with potential superadded infection. Samples of the fluid were positive for amylase, Candida krusei, and both gram-positive cocci and bacilli. Pharmacological management consisted of intravenous metronidazole and ciprofloxacin, with teicoplanin later initiated. Further definitive treatment included a plan for interventional radiology-guided percutaneous drainage of the tracking collection via the fistula. Discussion External fistulisation is more likely following pancreatic surgery or via existing drain sites, however in this case it developed spontaneously. A review of literature demonstrates multiple case reports regarding fistulisation; however, few present a case of fistulisation via the inguinal canal. Conclusions Subcutaneous fistulae secondary to a tracking pancreatic collection is a rare complication of pancreatitis. Although some cases may self-resolve, complications can occur which require urgent management. Patients who present in such cases should receive regular follow-up for the purpose of early detection of subsequent complications.