TY - JOUR

T1 - Pancreatic-portal vein fistula in acute pancreatitis successfully treated with endoscopic approach

AU - Poulsen, Valborg Vang

AU - Jensen, Annette Bøjer

AU - Hadi, Amer

AU - Ærenlund, Mia Prindahl

AU - Karstensen, John Gásdal

AU - Novovic, Srdan

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

U2 - 10.1055/a-2299-2052

DO - 10.1055/a-2299-2052

M3 - Comment/debate

C2 - 38663856

AN - SCOPUS:85191433302

VL - 56

SP - E354-E355

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

ER -