Can Creon, a pancreatic enzyme, caused damage to internal tissue if it gets into a enterocutaneous fistula?

WARNING, this post contains Medical Graphic Pictures below.

I can’t help wondering if Creon, a pancreatic enzyme, caused extra damage to internal tissue when it got into a gastrojejunostomy (GJ) stomach leak, then a enterocutaneous fistula? I had the Whipple Surgery in Nov 2023, then a few days post surgery developed a pancreaticojejunostomy (PJ) leak, followed by hepaticojejunostomy (HJ) leak, gastrojejunostomy (GJ), and a stubborn fistula. The gastrojejunostomy (GJ), the new connection between the stomach, and small bowel, didn’t show up on any CT scans, and wasn’t truly discovered till Mar 2024.

Do pancreatic enzyme need a stronger warning about the damage they can do to tissue?

The reason I ask the above question is: I was discharged from the hospital in early Jan 2024, I still had fluid/ paste leaking out the fistula located in the middle of my incision. When I was discharged it seemed that the leak, and fistula were healing. Jan 6, 2024, Home Care Nurse noted: “ There are 2 small opening in the incision”. On Jan 18, 2024 I saw the medical team, they prescribed Creon to help with digestion issues I was starting to have. I started taking the Creon that night, 1 pill Jan 18, 2 pills Jan 19, 1 pill Jan 20, but did not feel well, so had to stop. I didn’t take any Creon Jan 21st, 22nd, or 23rd. I emailed the medical team on Jan 20, 2024, explaining I was now having a strange feeling after taking Creon, like there was something in my stomach, or touching it. They asked me to try the Creon again, so on Jan 24, 2024 I started taking Creon again, 4 pills Jan 24, 3 pills Jan 25, 4 pills Jan 26, 3 pills Jan 27. On the morning of Jan 24, 2024 there was only one small opening( fistula) the Home Care Nurse could pack, the other had closed up. I was feeling very hopeful the leak, and fistula were healing. Jan 26, 2024, 3rd day taking Creon I started noticing strange material inside the wound manager bag covering the fistula, and stringy material hanging out of fistula. Jan 27, 2024, 11 pm I woke up, the wound manager was beginning to be leaking around the top edge, when I checked it, it fell off me. There was a new opening (now 2 larger openings) with a lot very strange fleshy material hanging out of both openings. I returned to the hospital on the morning of Jan 28, 2024, the ER report noted: “Significant serous discharge with extruded ?tissue”. I was admitted, and the nurse on the unit reported “ Writer removed the dressing and found a puddle of bile with mucous underneath. Cleaned with moist towels. Incision had large attached lump of slough. Writer cleaned around it several times. Skin surrounding was excoriated and painful. After a few wipes, the slough piece lifted on the right then completely, to reveal a crater-like hole approximately the size of a golf ball and about 2cm deep”.

Not sure why this happened, things appeared to be healing before I took the Creon, and that was the only major change I made when the problem started. The only warning there seems to be about it use is “ Do not crush or chew the Creon capsule or its contents, as they may cause irritation in your mouth”. The Creon is use to break down fats, carbohydrates, and protein. If it can cause irritation in your mouth, what happens if it gets into a fistula, and then in contact with unprotected tissue? Is there a stronger warning need for this medication? I still have a large scar where the fistula was, the tissue is much thinner than the surrounding tissue, and my abs are much weaker. No idea if there is more long term damage, or future complications. I feel I need to share this information so it may lead to further discussion, or research on the issues I experienced. A more complete account of the complications may be seen here, and used only with written consent.

UPDATE Nov 24, 2025: I am having tenderness on the right side of the Fistula scar, it maybe form all the internal damaged caused after I started taking Creon.