Pancreatic Pseudocyst-Portal Vein Fistula: Serial Imaging and Clinical Follow-up from Pseudocyst to Fistula

Abstract

The pancreatic pseudocyst is a very common complication of acute or chronic pancreatitis, usually by the latter and can also be caused by pancreatic trauma or surgery (1-3). The incidence of pseudocysts in chronic pancreatitis is 20–40% (1). Increased incidence of complications correlates directly with the duration of the pseudocyst and a 12% mortality rate was reported in untreated complicated pancreatic pseudocysts of more than 13 weeks (4). Communication of pancreatic pseudocysts with the pancreatic duct can be identified in 40–69% and pseudocysts containing active enzymes can cause potentially lethal complications (1, 4). Complications related to pancreatic pseudocysts include infection, hemorrhage, intraperitoneal rupture, fistula to adjacent organs, disseminated fat necrosis, arthritis, medullary bone necrosis, and vascular complications such as pseudoaneurysm, splenic vein obstruction, portal vein thrombosis or hypertension (1-5). A pancreatic fistula is an unexpected communication between the pancreas and the surrounding organs and can occur primarily as a result of trauma, pancreatic surgery and chronic pancreatitis. Pancreatic fistula usually associates with pancreatic pseudocyst and mostly communicates with skin and can also be communicated with other internal organs or spaces (2-5). Pancreatic-portal vein fistula is exceedingly rare and has been previously reported only 18 cases in medical literature written in English. And no reports, to date, have described the serial process of pancreatic pseudocyst-portal vein fistula. A case of pancreatic pseudocyst-portal vein fistula through clinical and radiological evaluation is presented.