Spontaneous pancreatic pseudocyst-portal vein fistula presenting with pancreatic ascites: strength of MR cholangiopancreatography

Abstract

Pancreatic pseudocyst-portal vein fistulae are a very rare complication of acute or chronic pancreatitis. Another late complication of chronic pancreatitis is pancreatic ascites. We report the case of a 43-year-old man with a spontaneous pseudocyst-portal vein fistula presenting with pancreatic ascites diagnosed by various imaging modalities, in order to emphasize the strength and efficacy of magnetic resonance cholangiopancreatography.

Pancreatic duct–portal vein communication: a case report

“…There are, however, reports of pancreatic pseudocysts communicating with the portal vein. 2,3 That is attributed to pancreatic enzyme-rich fluid causing…”

Pancreatic pseudocyst-portal vein fistula

“…Only 17 cases of pancreatic pseudocyst connecting with the portal venous system have been reported [4][5][6]. Several reports indicated that activated pancreatic enzymes in the pseudocyst might cause inflammation and directly contribute to cyst wall fragility and failure.…”

“…Several reports indicated that activated pancreatic enzymes in the pseudocyst might cause inflammation and directly contribute to cyst wall fragility and failure. These enzymes also cause erosion of the portal wall and induce venous thrombosis [4,7]. Spontaneous rupture of the pancreatic cyst occurred in about 5% of patients [7].…”

“…Most patients suffering from pancreatic pseudocyst-portal vein fistulae are asymptomatic or complained of mild abdominal pain. However, some patients have severe, life-threatening complications, such as massive bleeding in the digestive tract, septic shock, disseminated fat necrosis and intramedullary bone necrosis [4].…”

Spontaneous decompression of pancreatic pseudocyst presenting as haematemesis

“…One uncommon mechanism for bleeding in pancreatitis is the spontaneous rupture of a pseudocyst. Pseudocysts have been documented to spontaneously decompress by rupture into the stomach, 2 the small intestine, the colon as well as the portal vein 3 . Other mechanisms for bleeding in pancreatitis include portal hypertensive bleeding in the setting of extra‐hepatic portal hypertension due to splenic vein thrombosis, and rupture of a splenic artery or splenic artery aneurysm.…”