Factors associated with successful nonoperative management of colonic fistulas from necrotizing pancreatitis.

Authors

Divya L Deverakonda, Noah X Tocci, Breanna C Perlmutter, John McMichael, Daniel Joyce, Toms Augustin, Samer Naffouje, Robert F Naples, R Matthew Walsh, Robert Simon

Published in

Surgery. Pages 110618. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

Necrotizing pancreatitis can result in colonic fistulas from inflammatory sequelae or drain erosion. We sought to define the optimal operative management or nonoperative management of colonic fistulas secondary to necrotizing pancreatitis.
A retrospective analysis was performed of adult patients in an institutional necrotizing pancreatitis registry who developed colonic fistulas between 2015 and 2025. Patient cohorts were established by nonoperative management or operative management status, and exploratory univariate analysis was used to compare risk factors for operative management.
Among 1,092 necrotizing pancreatitis patients, 47 developed colonic fistulas. The median interval from initial acute pancreatitis diagnosis to colonic fistula was 58 (29-103) days. Nonoperative management was utilized in 20 (43%) patients with initial intervention, including 11 (55%) percutaneous or 4 (20%) endoscopic. Operative management was used in 27 (57%); initial interventions were 10 (37%) percutaneous and 17 (63%) upfront operative management. Twenty-three patients had drain-related colonic fistulas: 10 (50%) nonoperative management and 13 (48%) operative management. Nonoperatively managemed patients had significantly lower Bedside Index for Severity in Acute Pancreatitis (BISAP) scores on presentation to our institution (1.0 [1.0-2.0] vs 3.0 [1.0-3.0]; P = .04) with a BISAP score (≥3) associated with operative management (odds ratio, 6.10; 95% confidence interval, 1.59-30.68; P = .007). Nonoperatively managemed patients also had a shorter length of stay (10 [0-30] vs 39 [24-55] days; P < .01) and less frequent intensive care unit admission (7 [35%] vs 21 [78%]; P < .01). There was no significant difference in overall survival in nonoperative management versus operative management (P = .07).
While colonic fistulas are important to identify in patients with necrotizing pancreatitis, they do not mandate operative intervention. Our data suggest that low-risk patients, based on critically ill status and BISAP score, may undergo successful nonoperative management.

PMID:
42786087
Bibliographic data and abstract were imported from PubMed on 25 Sep 2026.

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