Biliopancreatic fistula with portal vein thrombosis caused by a pancreatic pseudocyst |
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Authors: | Hiroyuki Miyatani Noriyoshi Sagihara Yukio Yoshida Yoshihisa Suminaga |
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Institution: | (1) Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma, Omiya, Saitama 330-8503, Japan;(2) Department of Surgery, Tokyo-Kita Social Insurance Hospital, Tokyo, Japan |
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Abstract: | We encountered a very rare case of biliopancreatic fistula with portal vein thrombosis caused by pancreatic pseudocyst. A
57-year-old man was referred to our hospital because of abdominal pain, obstructive jaundice, and portal vein thrombosis due
to acute pancreatitis. Computed tomography showed a 7-cm-diameter pseudocyst around the superior mesenteric vein extending
towards the pancreatic head, dilatation of the intrahepatic bile duct, and portal vein thrombosis. Endoscopic retrograde pancreatography
revealed a main pancreatic duct with a pseudocyst communicating with the common bile duct. After pancreatic sphincterotomy,
a 7-F tube stent was endoscopically placed into the pseudocyst. However, a 6-F nasobiliary tube could not be inserted into
the bile duct because the fistula had a tight stenosis. Subsequently, the patient’s abdominal pain improved, the pancreatic
cyst disappeared, and the serum amylase level normalized. Two months after the endoscopic retrograde cholangiopancreatography,
percutaneous transhepatic biliary drainage was required because the patient’s jaundice became aggravated. Two weeks after
the choledochojejunostomy, the patient left the hospital in good condition. A follow-up computed tomography showed cavernous
transformation of the portal vein and no pancreatic pseudocyst. The patient remains asymptomatic for 2 years and 7 months
after surgery. Biliary drainage may be necessary for biliopancreatic fistula with obstructive jaundice in addition to pancreatic
cyst drainage. Biliopancreatic fistula can be treated by endoscopic procedure in some cases; however, surgical treatment should
be required in cases that are impossible to insert a biliary stent because of hard stricture. |
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Keywords: | Biliopancreatic fistula Pancreatic pseudocyst Portal vein thrombosis Pancreatitis |
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