Spontaneous pancreatic pseudocyst–portal vein fistula: a rare and potentially life threatening complication of pancreatitis

Raza, SS; Hakeem, A.; Sheridan, Maria; Ahmad, Niaz

doi:10.1308/003588413x13511609955616

Cited by 23 publications

(19 citation statements)

References 7 publications

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“…Treatment strategies for PPVFs highly differ in literature, ranging from medical supportive treatment to surgical interventions, with varying outcomes. Most reported cases who survived required aggressive surgical treatment including portal venoplasty (for primary closure of the fistula) or pancreatectomy and pancreaticojejunostomy (for blocking the flow of pancreatic secretions) as a definitive treatment [10] . In 1 reported case, a pancreatic stent alone was successfully used to treat the fistula [11] .…”

Section: Discussionmentioning

confidence: 99%

“…MRCP is a reasonable diagnostic confirmatory study, that can be followed by endoscopic retrograde cholangiopancreaticography if findings remain equivocal. Treatment decisions are made on a case‑by‑case basis, with conservative or minimally invasive approach favored in the acute stage, as surgery carries a high risk of mortality and morbidity [10] .…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous pancreatic pseudocyst – superior mesenteric vein fistula: A rare complication of chronic pancreatitis

Tomsan¹,

Hayeri²,

Babu³

2020

Radiology Case Reports

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Pseudocyst formation is common in chronic pancreatitis. A rare subset of these patients may develop fistulization between the pseudocyst and the portal vein system. We report a case of spontaneous pancreatic pseudocyst – superior mesenteric vein fistula in a 61-year-old male with a history of chronic recurrent calcifying pancreatitis. The fistulous connection was correctly identified on both computed tomography and magnetic resonance cholangiopancreatography (MRCP), and the patient was treated successfully with a conservative approach. Our case report aims to educate on this rare and potentially fatal vascular complication of chronic pancreatitis and to discuss the role of modern noninvasive imaging techniques, such as T2-weighted MRI/MRCP, in establishing this diagnosis and making a decision regarding its management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous pancreatic pseudocyst – superior mesenteric vein fistula: A rare complication of chronic pancreatitis

Tomsan¹,

Hayeri²,

Babu³

2020

Radiology Case Reports

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“…Having reviewed the literature, there are very few published reports of liver pseudocyst development as a direct consequence of invasion of the portal vein, or “fistulization” of a pancreatic pseudocyst 2 3 4 5 6 . In one case report outlining development of a pancreatic pseudocyst-portal vein fistula and thrombosis, the authors postulated the mechanism of a “high-pressure system” within the pseudocyst promoting deposition of pancreatic fluid material into the portal vein.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic pseudocyst-portal vein fistulization is a rarely described phenomenon within the literature 1 2 3 4 5 6 . We present two cases of patients with pancreatic pseudocysts fistulizing into the portal venous system and seeding to the liver with subsequent hepatic pseudocyst formation.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic pseudocyst-portal vein fistula with refractory hepatic pseudocyst: Two cases treated with EUS cyst-gastrostomy and review of the literature

et al. 2019

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Background and study aims Pseudocysts are the most common pancreatic cystic lesions and they usually develop in association with pancreatitis of at least 4 weeks’ duration. Extra-pancreatic pseudocysts, although reported, are relatively uncommon. Secondary liver pseudocysts are recognized within the literature, and most patients described have required percutaneous or surgical drainage due to infection or symptoms. The mechanism of hepatic pseudocyst formation is not entirely clear but it is postulated that this phenomenon may occur through pseudocyst-portal vein fistulization. We describe two cases of patients presenting with pancreatic pseudocysts invading the portal venous system with embolization of pancreatic fluid to the liver and subsequent hepatic pseudocyst formation. Interestingly, liver pseudocyst resolution was incomplete with antibiotics and percutaneous drainage alone, and only occurred following endoscopic ultrasonography-guided pancreatic cyst-gastrostomy and metal stent insertion. We have reviewed the current literature on the diagnosis and management of pseudocyst-portal vein fistula formation and we believe that our cases represent the first published within the literature to describe this treatment approach.

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“…[ 3 5 ] Others, however, like Dawson et al reported a PPVF that existed before portal vein thrombosis, suggesting that it is uninhibited pancreatic enzymes within a pseudocyst causing erosion of the portal venous wall and subsequent fistula formation. [ 6 7 ] It is important to note, however, that not all PPVFs are associated with pancreatic pseudocysts. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoportal Fistula Formation as a Consequence of Recurrent Acute Pancreatitis: Clinical and Imaging Considerations

Makary

Gayou

Kyrouac

et al. 2018

Journal of Clinical Imaging Science

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A pancreatic-portal vein fistula (PPVF) is an extremely rare complication of pancreatitis. In this report, we present a patient with a PPVF in the setting of recurrent pancreatitis and portal vein thrombosis diagnosed by cross-sectional imaging and endoscopic retrograde cholangio-pancreatography, who responded to medical management and anticoagulation. A critical review of this disease process is explored to highlight pathology, imaging characteristics, and essential alternative diagnostic considerations. We also discuss potential complications and current treatment strategies. PPVFs pose a unique diagnostic challenge and awareness of its clinical presentation can further improve patient outcomes.

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Spontaneous pancreatic pseudocyst–portal vein fistula: a rare and potentially life threatening complication of pancreatitis

Cited by 23 publications

References 7 publications

Spontaneous pancreatic pseudocyst – superior mesenteric vein fistula: A rare complication of chronic pancreatitis

Spontaneous pancreatic pseudocyst – superior mesenteric vein fistula: A rare complication of chronic pancreatitis

Pancreatic pseudocyst-portal vein fistula with refractory hepatic pseudocyst: Two cases treated with EUS cyst-gastrostomy and review of the literature

Pancreaticoportal Fistula Formation as a Consequence of Recurrent Acute Pancreatitis: Clinical and Imaging Considerations

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