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DOI: 10.1055/a-2299-2052
Pancreatic-portal vein fistula in acute pancreatitis successfully treated with endoscopic approach
Acute pancreatitis is associated with numerous complications. Pancreatic-portal vein fistula (PPVF) is an exceptionally rare and diagnostically challenging example [1] [2]. A 63-year-old man was admitted due to abdominal pain, weight loss, newly diagnosed diabetes, and elevated liver enzymes. Contrast-enhanced computed tomography revealed acute pancreatitis with fluid exudation and a necrotic collection in the head of the pancreas, accompanied by attenuation of fluid in the portal vein. Subsequent magnetic resonance cholangiopancreatography raised suspicion of PPVF.
Endoscopic retrograde cholangiopancreatography (ERCP) identified a stenosis in the pancreatic duct (PD) at the head of the pancreas, associated with an upstream fluid collection and a fistula into the portal vein. The PD was not visible as the contrast injection passed into the portal vein ([Video 1]). The therapeutic intervention included pancreatic sphincterotomy with dilation of the PD stenosis with a 6-mm balloon catheter. Two 7 cm × 7 Fr double-pigtail stents were positioned within the fluid collection. The patient developed septicemia, which was treated with antibiotics. The patient was discharged after 45 days of hospitalization.
Quality:
At ERCP 2 months later, no communication between the PD and portal vein was evident, but the stenosis of the PD had recurred ([Fig. 1]). The stenosis was dilated using a 4-mm balloon catheter, and one 7-Fr and one 5-Fr pancreatic stent were placed. The stents were replaced biannually during the following 12 months. There was no sign of PPVF, and the PD was patent, without stenosis. At 2.5 years’ follow-up, the patient was asymptomatic regarding acute pancreatitis and PPVF.
This case highlights the importance of recognizing PPVF as a potential complication of acute pancreatitis and not solely associated with chronic pancreatitis. The patient’s long-term survival underscores the significance of tailored interventions achieving favorable outcomes in complex complications of acute pancreatitis.
Endoscopy_UCTN_Code_CCL_1AZ_2AH
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Phillips AE, Paniccia A, Dasyam A. A rare complication of chronic pancreatitis. Gastroenterology 2020; 159: 16-17
- 2 Cho YD, Cheon YK, Cha SW. et al. Pancreatic duct-portal vein fistula. Gastrointest Endosc 2003; 58: 415
Correspondence
Publication History
Article published online:
25 April 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Phillips AE, Paniccia A, Dasyam A. A rare complication of chronic pancreatitis. Gastroenterology 2020; 159: 16-17
- 2 Cho YD, Cheon YK, Cha SW. et al. Pancreatic duct-portal vein fistula. Gastrointest Endosc 2003; 58: 415