Refractory pancreatic fistula following distal pancreatectomy successfully treated with N-butyl-2-cyanoacrylate and vascular embolization coils using a pull-through technique

Abstract Postoperative pancreatic fistula (PF) remains a serious complication after distal pancreatectomy (DP), particularly when it is refractory to standard management. Herein, we report a case of refractory Grade C PF following DP for pancreatic adenosquamous carcinoma. Despite conservative treatment, repeated image-guided percutaneous drainage, and endoscopic pancreatic duct stenting, the fistula persisted and was complicated by gastroduodenal artery bleeding and duodenal perforation. Given the patient’s early postoperative recurrence, poor prognosis, and high surgical risk, further surgical intervention was considered inappropriate. Pancreatic duct stump embolization using N-butyl-2-cyanoacrylate and vascular embolization coils was performed via a pull-through technique connecting the papilla of Vater to the percutaneous drainage route, resulting in successful closure of both the pancreatic duct and duodenal fistula. In selected patients with refractory PF, this approach may serve as a salvage treatment option when conventional therapies have failed or are overwise inappropriate.