Pancreatic duct-portal vein fistula

doi:10.1016/0016-5085(89)91514-X

Gastroenterology

Volume 97, Issue 4, October 1989, Pages 1025-1027

https://doi.org/10.1016/0016-5085(89)91514-X Get rights and content

Abstract

We describe a case of pancreatic duct-portal vein fistula discovered by endoscopic retrograde cholangiopancreatography, with confirmatory computed tomography and angiographie studies. The fistula was associated with chronic pancreatitis that was complicated by recurrent gram-negative bacteremia and peripheral subcutaneous fat necrosis, although pancreatic pseudocyst was not present. Even though surgical treatment was recommended, medical complications precluded surgery and the patient recovered with supportive therapy only. Follow-up endoscopic retrograde cholangiopancreatography showed spontaneous closure of the fistulous connection.

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Cited by (34)

Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications—13-Year Experience of a Pancreas Center of Excellence
2021, Journal of Gastrointestinal Surgery
To determine factors affecting mortality, and long-term patency of portal vein, in patients with pancreatic-portal vein fistula (PPVF).
Consecutive cases of PPVF at the University of Pittsburgh Medical Center from 2008 to 2020 were retrospectively identified. Clinical history, imaging studies, management strategies, complications, and long-term outcomes were analyzed.
Fourteen patients, representing the largest PPVF cohort reported to date (mean age 58.6 years, 64.3% women, median follow-up 10 months [1–98 months]) were identified. Underlying chronic pancreatitis was seen in 9 (64.3%) patients, while 5 (35.7%) developed PPVF with first attack of acute pancreatitis. PPVF involved proximal main portal vein (MPV) in 10 (78.6%) patients. Of the 5 patients (35.7%) who died, all had occlusive (n=4) or near-occlusive (n=1) PPVF-associated filling defect (FD) in the MPV. Conversely, 7 of 9 survivors (87.5%) had subocclusive FD and patent MPV. In patients with sepsis (n=5), 1 underwent surgical necrosectomy and survived, while 3 of 4 (75%) patients without debridement died.
Occlusive/near-occlusive PPVF-associated MPV FD, and sepsis, are associated with high mortality rates, while subocclusive MPV FD is associated with survival and long-term MPV patency. PPVF is a potentially life-threatening, and possibly under-diagnosed, entity that warrants early clinical suspicion for timely diagnosis, to facilitate optimal management.
A Rare Complication of Chronic Pancreatitis
2020, Gastroenterology
A pancreatic pseudocyst-portal vein fistula closed by endoscopic pancreatic stent insertion
2010, Gastrointestinal Endoscopy
Citation Excerpt :
Conservative management can be effective for patients who are asymptomatic or have mild symptoms. Among the 16 reported cases, however, improvement with conservative management was observed in only 3 cases.1,2,6,7 Most cases required aggressive surgical treatment including portal vein plasty (for primary closure of the fistula) or pancreatectomy and pancreaticojejunostomy (for blocking pancreatic flow into the pseudocyst and thus closing the fistula).
Pancreatico-portal fistula after acute pancreatitis
2008, Gastroenterologie Clinique et Biologique
Aneurysm and Arteriovenous Fistula of the Liver and Pancreatic Vasculature
2006, Surgery of the Liver, Biliary Tract and Pancreas: Volumes 1-2, Fourth Edition
Endoscopic sealing of pancreatic fistula by using N-butyl-2-cyanoacrylate
2004, Gastrointestinal Endoscopy
The treatment of pancreatic fistula can be difficult. A novel endoscopic approach to sealing pancreatic fistulas by using N-butyl-2-cyanoacrylate is described.
Twelve patients with pancreatic fistulas underwent endoscopic injection of N-butyl-2-cyanoacrylate into the fistulous tract, in addition to endoscopic drainage.
Fistulas were closed successfully in 8 of 12 patients. A single treatment session was successful in 7 patients; a second session was required in one patient. In two patients, closure was temporary, and, in one patient, the treatment failed. One patient died 24 hours after treatment. He developed a pulmonary thromboembolism from a left popliteal vein thrombosis and died from complications of surgical thromboembolectomy. At autopsy, a pulmonary embolus was found, but there was no evidence of N-butyl-2-cyanoacrylate in the lungs. No procedure-related complication occurred over a median follow-up of 20.7 months (range 9-51 months).
In this preliminary study, occlusion of pancreatic fistulas by using N-butyl-2-cyanoacrylate glue was safe and effective, and obviated the need for surgery in a substantial proportion of patients. Further studies of the use of N-butyl-2-cyanoacrylate for closure of pancreatic fistula are warranted.

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Brief reportPancreatic duct-portal vein fistula

Abstract

Am J Surg

Pancreatic injuries and fistulas

Pancreatic pleural fistula: demonstration by computed tomography after endoscopic retrograde pancreatography

Am J Gastroenterol

Pleuropancreatic fistula: endoscopic retrograde cholangiopancreatography and computed tomography

AJR

The use of endoscopic retrograde choledochopancreatography (ERCP) in the diagnosis of internal fistulae complicating severe acute pancreatitis

Br J Radiol

Use of ERCP in the diagnosis of internal pancreatic fistula

Gut

Internal pancreatic fistulas: pancreatic ascites and pleural effusions

Ann Surg

Pancreaticobronchial fistula: case report and review of the literature

Gastroenterology

Brief report
Pancreatic duct-portal vein fistula