Case report of a pancreatic pseudocyst ruptured into the splenic vein causing extrahepatic portal hypertension

Abstract

In a 42 year old female, a fistula developed between the splenic vein and the pancreatic duct through the cavity of a pseudocyst in the tail of the pancreas and resulted in an extrahepatic portal hypertension. The fistula was visualized by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic portography, then was successfully resected by surgery. The possible etiology of extended obstruction of both splenic and portal veins in chronic pancreatitis with pseudocyst was discussed.

Rupture of a pancreatic pseudocyst into the portal venous system

“…However, intrahepatic pseudocysts are rare, with few reports in the literature of rupture into the portal vein [1][2][3][4]. The pathogenesis of intrahepatic formation of the pseudocyst appears controversial.…”

Fistula of a pancreatic pseudocyst into the superior mesenteric and portal veins causing erythema nodosum and aseptic polyarthritis - case report and review of literature

“…There have been twenty-two previously documented cases of fistulae between a pancreatic pseudocyst and the portal vein (PPF) [5,6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; almost all of these being single case reports. Together with this currently reported case these have been predominantly male patients (82% or 19/23 patients) with a mean age of 50 years (range 29-82 years) at presentation and most had a history of chronic alcohol abuse and chronic pancreatitis.…”

“…Of the (now 23) reported PFF cases, four (17%) were diagnosed through ERCP [5,6,23,24], four (17%) through cystography [19,20,27], three (13%) through PTP [18, 21,22], two (11%) through MRI/MRCP [25,26], one through CT [28], and one (4%) through angiography [11].…”

“…Pancreatic pseudocysts often follow acute pancreatitis, and though they can resolve spontaneously, they can also be associated with potential complications. These include bleeding [1,2], ruptures into the abdominal cavity [3], splenic vein obstruction [4], portal vein thrombosis [5,6], and the formation of fistulae into the surrounding organs [6,7,8] and the inferior vena cava [9]. Erosion of a pancreatic pseudocyst into the portal vein to create a pancreas duct-portal vein fistula (PPF), however, is extremely rare with only 22 other previously reported cases [5,6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”