Biliopancreatic Fistulas Complicating Pancreatic Pseudocysts: A Report of Three Cases Demonstrated by Endoscopic Retrograde Cholangiopancreatography

Three patients were found to have fistulation of the pancreatic and common bile ducts, complicating chronic pancreatitis in one patient and acute pancreatitis in two patients. Closure of the fistula was achieved with biliary and pancreatic stenting in one patient; the other two patients were treated surgically because endoscopic treatment had failed. The clinical and radiological features of this exceptional complication are presented, with a brief review of the topic.

References

• 1 Sarles H, Sarles J C, Guien C. études des voies biliaires et pancréatiques au cours de la pancréatite chronique.  Arch Fr Mal App Dig Nutr. 1958;  47 664-683
• 2 Kozarek R A, Traverso L W. Pancreatic fistulas: aetiology, consequences, and treatment.  Gastroenterology. 1996;  4 238-244
• 3 Lipsett P A, Cameron J L. Internal pancreatic fistulas.  Am J Surg. 1992;  163 216-220
• 4 Sankaran S, Walt A J. The natural and unnatural history of pancreatic pseudocyst.  Br J Surg. 1975;  62 37-44
• 5 Clements J L, Bradley E L, Eaton S B. Spontaneous internal drainage of pancreatic pseudocyst.  Am J Roentgenol. 1976;  126 985-991
• 6 Saeed Z A, Ramirez F, Hepps K S. Endoscopic stent placement for internal and external pancreatic fistulas.  Gastroenterology. 1993;  105 1213-1217
• 7 Miller B M, Traverso L W, Freeny P C. Intrapancreatic communication of bile and pancreatic ducts secondary to pancreatic necrosis.  Arch Surg. 1988;  123 1000-1003
• 8 Lebovics E, Mittelman A, Del Guercio L RM, et al. Pancreaticobiliary fistula and obstructive jaundice complicating I¹²⁵ interstitial implants for pancreatic cancer: endoscopic diagnosis and management.  Gastrointest Endosc. 1990;  6 610-611
• 9 Schoefl R, Haefner M, Pongratz S ,. et al . Endoscopic treatment of fistulas and abscesses in pancreatitis: three case reports.  Endoscopy. 1996;  28 776-779
• 10 Skellenger M E, Patterson D, Foley N T, Jordan P H. Cholestasis due to compression of the common bile duct by pancreatic pseudocysts.  Am J Surg. 1983;  145 343-348
• 11 Hauptmann E M, Wojtowycz M, Reichelderfer M, McDermott J C. Pancreatic pseudocyst with fistula to the common bile duct: radiological diagnosis and management.  Gastrointest Radiol. 1992;  17 151-153
• 12 Gadacz T R, Lillemoe K, Zinner M, Merril W. Common bile duct complications of pancreatitis evaluation and treatment.  Surgery. 1983;  93 (2) 235-242
• 13 Dalton W E, Lee H M, Williams G M, Hume D M. Pancreatic pseudocyst causing hemobilia and massive gastrointestinal hemorrhage.  Am J Surg. 1970;  120 106-107
• 14 Ro J o, Yoon B H, Puppula A R. Pancreatic pseudocyst as a cause of gastrointestinal bleeding and hemobilia.  Am J Gastroenterol. 1976;  66 287-291
• 15 De Vanna T, Dunne M G, Haney P J. Fistulous communication of pseudocyst to the common bile duct: a complication of pancreatitis.  Pediatr Radiol. 1983;  13 344-345
• 16 Ellenbogen K A, Cameron J L, Cocco A E,. et al . Fistulous communication of a pseudocyst with the common bile duct: demonstration by endoscopic retrograde cholangiopancreatography.  Johns Hopkins Med J. 1981;  149 110-111
• 17 Bresler L, Vidrequin A, Poussot D , et al. Fistulous communication of a pancreatic pseudocyst with the common bile duct: demonstration by operative cholangiogram.  Am J Gastroenterol. 1989;  84 835-836
• 18 Grace R R, Jordan Ph. Unresolved problems of pancreatic pseudocyst.  Ann Surg. 1976;  184 16-21
• 19 Glass R L, Newstedt J R. Hemobilia: an usual complication of chronic pancreatitis.  Missouri Med. 1964;  61 853
• 20 Jenkins S A, Nott D M, Baxter J N. Fluctuations in the secretion of pancreatic enzymes between consecutive doses of octreotide: implications for the management of fistulae.  Eur J Gastroenterol Hepatol. 1995;  7 255-258
• 21 Sauerbruch T, Weinzierl M, Holl J, Pratschke E. Treatment of postoperative bile fistulas by internal endoscopic biliary drainage.  Gastroenterology. 1986;  90 1998-2003
• 22 Kozarek R A, Ball T J, Patterson D J, et al. Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections.  Gastroenterology. 1991;  100 1362-1370
• 23 Hämäläinen K P, Halme L, Tierala E. Endoscopically inserted stent as treatment for pancreatic ascites.  Acta Radiol. 1997;  38 550-552
• 24 Gane E, Fata'ar S, Hamilton I. Management of a persistent pancreatic fistula secondary to a ruptured pseudocyst with endoscopic insertion of an expandable metal stent.  Endoscopy. 1994;  26 254-256