Benign Intraductal Papillary-Mucinous Neoplasm of the Pancreas Associated with Spontaneous Pancreaticogastric and Pancreaticoduodenal Fistulas

Abstract

Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.

Intraductal Papillary Mucinous Neoplasm with Pancreatogastric Fistula

“…To our knowledge, there have been 8 published reports comprising 15 cases of IPMN with pancreatogastric fistulas (Table) (6-13). Koizumi et al (10) reported that the duodenum (24 cases, 59%), common bile duct (21 cases, 51%), and stomach (7 cases, 17%) were the organs most frequently affected by fistula formation. Kobayashi et al (6) observed fistula in other organs in 18 of 274 (6.6%) patients, 10 of whom had main-duct IPMN, 8 branch-duct IPMN, and 8 pancreatogastric formation.…”

Gastroduodenal Artery Psuedoaneurysm Bleed through a Spontaneous Pancreaticoduodenal Fistula as a Result of Acute Necrotizing Pancreatitis

“… 10 Spontaneous pancreaticoduodenal fistulas are not uncommon; depending on the study population, the incidence varies from 3% to 47%. 11 - 14 Duodenal and colonic fistulas occur more frequently compared to other sites due to their anatomic proximity. The majority of fistulas in the upper GI tract close spontaneously and can be managed conservatively compared to colonic fistulas, which require a higher rate of intervention.…”

Uncommon acquired fistulae involving the digestive system: summary of data

“…A rarer cause of pancreatic fistula is intraductal pancreatic mucinous tumor (IPMT). Case reports of IPMT leading to fistula to the stomach, duodenum, bile duct, and colon have been reported [37][38][39]. Abundant secretion of mucus leading to pressure necrosis is thought to be the etiology of fistula formation in some of the patients [38].…”