Pancreaticocolonic fistula resolved through conservative management: a case that defies the norm.

Spontaneous fistulization of pancreatic collections into the colon is a rare complication of necrotizing acute pancreatitis, with an incidence of less than 3% and high morbidity and mortality. We present the case of a 47-year-old male with severe necrotizing acute pancreatitis who developed a 12 mm pancreaticocolonic fistula between an infrapancreatic retroperitoneal collection and the hepatic flexure of the colon. Given the patient's clinical stability, a conservative approach was adopted, consisting of broad-spectrum antibiotic therapy, parenteral nutrition, and close radiological monitoring. Within two months, imaging studies demonstrated complete resolution of the fistula without the need for surgical or endoscopic intervention. This case highlights the potential for successful conservative management in hemodynamically stable patients, offering a less invasive alternative in selected clinical scenarios.