Effectiveness of Endoscopic Pancreatic Stenting for Pancreatic Pseudocyst-Portal Vein Fistula

Abstract

Pancreatic pseudocyst-portal vein (PP-PV) fistula, mostly occurring after pseudocyst formation following acute/chronic pancreatitis, is a rare but life-threatening condition. The majority of treatments are based on conservative or surgical interventions. We report the case of a 70-year-old man with a PP-PV fistula and PV thrombosis. We adopted conservative treatment at first due to his mild symptoms. However, after resuming food intake, the patient had severe abdominal pain. Following endoscopic retrograde cholangiopancreatography, we found that the pseudocyst was connected with the PV through the fistula. Subsequently, an endoscopic nasopancreatic drainage (ENPD) catheter was inserted into the main pancreatic duct to establish pancreatic drainage, which resulted in a decrease in the abdominal pain. After the ENPD tube had been exchanged for endoscopic pancreatic stenting, his abdominal pain did not recur. Therefore, this case demonstrated endoscopic treatment as an effective treatment option for PP-PV fistula.

Spontaneous Pancreatic Pseudocyst-Superior Mesenteric Vein Fistula

“…1,[3][4][5][6] It is also possible that the fistula develops first because of pancreatic enzymes destroying the pseudocyst and vein walls and inflammation from the pancreatic enzymes within the vein leads to thrombosis. 1,3,[5][6][7][8] Several cases that involved serial imaging documented the presence of fistula before thrombosis, suggesting that at least in some cases, the second theory seems more likely. 4,8 CT is a common initial imaging modality for patients with PP-PV fistulas.…”

“…1,2 Fistula development between pancreatic pseudocysts and the portal venous system is exceedingly rare. 3 This complication has been described more frequently in men and those with significant alcohol use. 1,[4][5][6] Most cases develop in the context of chronic pancreatitis and less commonly during episodes of acute pancreatitis.…”

“…One possible explanation is that the thrombus develops first because of stasis from compression of the vein by the pseudocyst and the thrombus then acts as a nidus for the fistula to develop. 1,[3][4][5][6] It is also possible that the fistula develops first because of pancreatic enzymes destroying the pseudocyst and vein walls and inflammation from the pancreatic enzymes within the vein leads to thrombosis. 1,3,[5][6][7][8] Several cases that involved serial imaging documented the presence of fistula before thrombosis, suggesting that at least in some cases, the second theory seems more likely.…”

“…10 Endoscopic stenting of the pancreatic duct has been effective in certain cases and resulted in clinical improvement in the case described in this report. 3,11,12 A treatment algorithm proposed by Ng et al 8 suggested conservative therapy with percutaneous drainage in cases in which the pseudocyst does not communicate with the pancreatic duct and endoscopic stenting in cases in which communication is present. Given the high rates of mortality in surgically managed cases, we agree with this approach for patients who can tolerate endoscopy.…”

Preoperative prediction of early recurrence of HBV-related hepatocellular carcinoma (≤5 cm) by visceral adipose tissue index

“…A single unenhanced axial slice (layer thickness of 1.5 mm) at the L3 vertebral center was selected independently, the abdominal adipose tissue was delineated three times using ImageJ software and the average values were recorded (Figure 1). Then we used the abdominal adipose tissue divided by height (cm 2 /m 2 ) to obtain the VATI and SATI as reported in the literature (17).…”