S1487 Simultaneous Pancreatico-Enteric Fistulae: A Complication of Pancreatic Intraductal Papillary Mucinous Neoplasm

A Case of a gastropancreatic fistula in the setting of intraductal papillary mucinous neoplasms

“…IPMNs are generally complicated by biliary/pancreatic ductal dilation, pancreatitis, hemorrhage, acute pancreatitis, abscess, or perforation; however, fistulation is not common [3] . The first known case of fistulation to adjacent organs was reported in 1980 as a pancreaticobiliary fistula, however other studies have shown fistula formation in the duodenum, common bile duct or stomach [1 , 4] .…”

“…Main duct-IPMN's however, are not found in multiple organs simultaneously [9] . Fistula formation into an adjacent structure may occur from direct invasion, elevated intraductal pressures, or secondary to inflammation [3] .…”

“…Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are a spectrum of benign to malignant neoplasms, characterized by papillary proliferations of mucin-producing epithelial cells, ductal dilation and cyst formation [1] , [2] , [3] . IPMNs have different subtypes, however, all originate from epithelial cells of the pancreatic ducts [4] .…”

“…Many patients are asymptomatic with IPMNs being identified incidentally [2 , 3] . The clinical approach to management is contingent on clinical risk factors, symptoms, complications and potential for progression to invasive carcinoma.…”