Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review

Koizumi, Masaru; Sata, Naohiro; Yoshizawa, Kenichi; Tsukahara, Munetoshi; Kurihara, Kei; Yasuda, Yoshikazu; Nagai, Hideo

doi:10.1186/1477-7819-3-70

Cited by 30 publications

(8 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fistulas between the IPMN and the adjacent organs [4,5,7,8] are usually associated with an invasive carcinoma and involve the duodenum (64%), the common bile duct (56%) or the stomach (17%) [5]. There are 5 reported cases of IPMN associated with a pancreaticogastric fistula in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…There are 5 reported cases of IPMN associated with a pancreaticogastric fistula in the literature. Four of these were malignant tumors and the 5th was a noninvasive carcinoma occurring after ERCP; in this case, it was assumed that the determining factor for the appearance of a fistula was the increase in pressure in the pancreatic duct during ERCP [4]. The physiopathological mechanism for the formation of pancreaticogastric and pancreaticoduodenal fistulas is not entirely known.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, in our case, no sign of invasion was observed. Mucin lakes were present at the contact of branch ducts and may have increased the intraductal pressure, resulting in ductal dilatation and wall disruption, finally leading to the fistula [4,5]. The chronic inflammatory pattern of the pancreatic tissue may also have contributed to the formation of fistulas [4].…”

Section: Discussionmentioning

confidence: 99%

“…Several cases of pancreaticogastric fistulas have been described in the literature, but to our knowledge, only 1 case has been reported involving a noninvasive IPMN, which was presumed to be secondary to an endoscopic retrograde cholangiopancreatography (ERCP) [4]. …”

Section: Introductionmentioning

confidence: 99%

“…IPMNs are generally considered slowly growing tumors with a good outcome after surgical resection, but invasive ones have been associated with a poorer prognosis [4]. …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

et al. 2010

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…IPMNs are generally considered slowly growing tumors with a good outcome after surgical resection, but invasive ones have been associated with a poorer prognosis [4]. …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2010

View full text Add to dashboard Cite

show abstract

Intraductal papillary mucinous neoplasm penetrating to the stomach, duodenum, and jejunum demonstrated on MR cholangiopancreatography with an oral negative contrast agent

Tajima

Utano

Kijima

et al. 2012

J. Magn. Reson. Imaging

View full text Add to dashboard Cite

A 65-year-old man was referred to our hospital due to epigastric pain. Abdominal enhanced computed tomography (CT) demonstrated marked dilatation of the main pancreatic duct (MPD) and communication to the gastric and duodenal lumen was suspected. Esophagogastroduodenoscopy (EGD) showed a villous tumor with white mucous discharge in the posterior wall of the gastric corpus and duodenal bulb. Pathological specimens showed mucin-producing epithelium with nuclear atypia that had developed in a papillary form. Based on these findings, we diagnosed intraductal papillary mucinous neoplasm (IPMN) arising in the MPD with penetration into the gastric and duodenal lumen. Magnetic resonance cholangiopancreatography (MRCP) with an oral negative contrast agent (manganese chloride tetrahydrate) showed a fistulous tract not only to the stomach and duodenum, but also to the jejunum. MRCP demonstrated mucous streaming with remarkably high intensity. In this case, an oral negative contrast agent was useful to distinguish mucous discharge from gastric fluid, facilitating the diagnosis of penetration to the jejunum. This finding was unobtainable by CT or EGD. When IPMN penetrating to other organs is suspected, MRCP with an oral negative contrast agent may provide important information.

show abstract

Intraductal Papillary Mucinous Neoplasm (IPMN)

Morana

D’Onofrio

Martini³

et al. 2022

Imaging and Pathology of Pancreatic Neoplasms

View full text Add to dashboard Cite

Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review

Cited by 30 publications

References 5 publications

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

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

Intraductal papillary mucinous neoplasm penetrating to the stomach, duodenum, and jejunum demonstrated on MR cholangiopancreatography with an oral negative contrast agent

Intraductal Papillary Mucinous Neoplasm (IPMN)

Contact Info

Product

Resources

About