Pancreatic fistulas can be internal or external and the consequence of acute or chronic pancreatitis, malignancy, or trauma (to include pancreatic surgery, pseudocyst drainage, and percutaneous biopsy). Contingent on the presence of concomitant pseudocyst, downstream ductal obstruction, or a disconnected duct syndrome, treatment may include maneuvers to decrease pancreatic secretion (NPO, hyperalimentation, pancreatic enzymes, octreotide), attempts to effect serosal apposition (diuretics, thoracentesis, paracentesis), various types of percutaneous tube manipulation, or surgery. Transpapillary pancreatic duct stents have recently been used for refractory ductal leaks and may work either by direct occlusion of the fistula or by lowering the duodenal-pancreatic pressure gradient.