Diagnosis of pancreatic duct-portal vein fistula; a case report and review of the literature

Abstract

Pseudocysts containing activated enzymes are a common complication of pancreatitis. Pseudocysts can rupture into adjacent structures including the peritoneal cavity, adjacent organs, and rarely vascular structures. While arterial pseudoaneurysms and venous thrombosis or occlusion are well known complications of acute and chronic pancreatitis, only 17 cases of pancreas-portal venous fistula have been encountered in review of the literature. A patient with chronic pancreatitis presented with a history of weight loss, fatigue and was found to have a pancreatic duct-portal vein fistula. The patient was treated surgically with good outcome.

An Exceptional Cause of Abdominal Pain

“…Such pancreas-portal venous fistulas are extremely rare, with <20 cases reported in published literature. 1 The location of the fistula is within the head of the pancreas in most cases, and it is associated with intrapancreatic necrotic collection in close proximity to the portal vein, as in the present case. The intravascular flow of pancreatic enzymes leads to local and progressively extensive portal vein thrombosis.…”

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

“…[ 4 ] Some authors suggested that the primary pathogenesis is related to the portal vein thrombosis acting as nidus for fistula formation. [ 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.…”

“…[ 6 7 ] It is important to note, however, that not all PPVFs are associated with pancreatic pseudocysts. [ 5 ]…”

“…Direct visualization of a T2-hyperintense fistulous tract may be seen and can be highlighted by the use of three-dimensional rendering techniques. [ 5 ] However, not all fistulous communications may be seen by MRI. Ultrasound evaluation likewise demonstrates complex fluid within the portal vein with absent flow on Doppler interrogation.…”

Percutaneous Management of Portal Vein Patency and Integrity Problems - Catheter Directed Local Thrombolysis, Stenting, Endoluminal RFA & Angioplasty by Balloon or Stenting

“…Such pathologies, as thrombophilic conditions, pancreatitis also major abdominal surgery and repetitive abdominal trauma may cause SMV and PV thrombosis requiring percutaneous thrombectomy and thrombolysis and vascular stent placement (11,12,13).…”