Pancreatic fistulas occur when the pancreatic duct or one of its branches is disrupted either by direct trauma or as a result of inflammatory disease. They may communicate externally with the skin or, less frequently, internally with a variety of hollow organs or a body cavity. Complications associated with pancreatic fistulas are many and include sepsis, fluid and electrolyte losses, bleeding, pulmonary problems, malabsorption, skin breakdown, and autodigestion or erosion of adjacent viscera. There is a substantial mortality risk of 8% to 10% associated with the development of a pancreatic fistula. 7,9 Most deaths are due to intra-abdominal sepsis or hemorrhage. The therapy for pancreatic fistulas has largely been conservative, with operation being reserved for those patients with prolonged outputs or life-threatening complications. Despite pharmacologic suppression of pancreatic exocrine secretion and advances in endoscopic and percutaneous therapeutic techniques, pancreatic fistula continues to be a source of morbidity and mortality following pancreatic surgery, splenectomy, pancreatic trauma, and pancreatitis.