1
|
Ding C, Yang JF, Yang B, Lu W, Wang X, Zhou YF, Zhang XF. A pancreaticogastric fistula related to intraductal papillary mucinous neoplasm of the pancreas developed during follow-up: A case report and literature review. J Dig Dis 2024; 25:140-146. [PMID: 38433115 DOI: 10.1111/1751-2980.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Cong Ding
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Jian Feng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Bin Yang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
| | - Wen Lu
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Xia Wang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Yi Feng Zhou
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| | - Xiao Feng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang Province, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province Hangzhou, Hangzhou, Zhejiang Province, China
| |
Collapse
|
2
|
Chan WH, Chen CM, Wang SY, Wu RC, Chen TC, Lee HK, Lin CH, Yeh CN. Intraductal papillary neoplasm of the bile duct presenting with hepatogastric fistula: a case report and literature review. Front Oncol 2023; 13:1193918. [PMID: 37274235 PMCID: PMC10237316 DOI: 10.3389/fonc.2023.1193918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is an uncommon entity characterized by papillary growth within the bile duct lumen. IPNB is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas, which sometimes complicates with fistula formation to adjacent organs, mainly due to high-pressure related erosion from mucin-filled ducts. However, fistula formation from IPNB is quite rare. Here we report a case of IPNB complicated with hepatogastric fistula. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed disproportional dilatation of left intrahepatic duct with intraluminal soft tissue nodules and fistulous connections to gastric high body. Endoscopy revealed ulcers with two fistulous orifices at upper gastric body. The patient underwent left hepatectomy with gastric wedge resection. Histopathology examination revealed IPNB with invasive cholangiocarcinoma, directly invading to gastric wall leading to hepatogastric fistula. In summary, we have presented the clinical, imaging and pathological findings, along with a comprehensive review of relevant literature, in order to enhance the understanding of this rare condition.
Collapse
Affiliation(s)
- Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Ming Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Tse-Ching Chen
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Hao-Kang Lee
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
3
|
Patel S, Al Salmi U, Al Shamousi K. Main-Duct Intraductal Papillary Mucinous Neoplasm Complicated by a Pancreaticogastric Fistula and a Pancreaticocholedocal Fistula. Cureus 2023; 15:e38502. [PMID: 37273307 PMCID: PMC10238077 DOI: 10.7759/cureus.38502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a spectrum of benign to malignant epithelial neoplasms that are characterized by papillary proliferation, duct dilation, and cyst formation. A rare complication of IPMNs is fistula formation into adjacent organs such as the duodenum, biliary system, and stomach. Here, we report a case of IPMN with a pancreaticobiliary fistula and pancreaticogastric fistula. An 84-year-old woman with early Alzheimer's disease was diagnosed with IPMN of the pancreas. She deferred surgery given her age and remained asymptomatic for five years until presenting with cholangitis. She had been further evaluated and was found to have a pancreaticobiliary fistula, which was treated with biliary stent placement. Her subsequent admission involved the formation of a new pancreaticogastric fistula. This case highlights potential complications of excess mucin production from unresected IPMNs and demonstrates a guarded prognosis in elderly patients.
Collapse
Affiliation(s)
- Sarvanand Patel
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, USA
| | - Umaima Al Salmi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | | |
Collapse
|
4
|
Mayer P, Héroin L, Sosa-Valencia L, Dautrecque F, Pessaux P, Saviano A, Habersetzer F. An impossible biliary drainage? Fistulization of a degenerated intraductal papillary mucinous pancreatic neoplasm to the common bile duct. Endoscopy 2022; 55:E39-E41. [PMID: 36138528 PMCID: PMC9812682 DOI: 10.1055/a-1930-5917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Pierre Mayer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France,Institut Hospitalo Universitaire Strasbourg, Strasbourg, France
| | - Lucile Héroin
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France,Institut Hospitalo Universitaire Strasbourg, Strasbourg, France
| | | | - Flavien Dautrecque
- Department of Hepatology and Gastroenterology, Centre Hospitalier de Lens, Lens, France
| | - Patrick Pessaux
- Institut Hospitalo Universitaire Strasbourg, Strasbourg, France,Department of Visceral and Digestive Surgery Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France,Inserm U1110, Institute for Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| | - Antonio Saviano
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France,Institut Hospitalo Universitaire Strasbourg, Strasbourg, France,Inserm U1110, Institute for Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| | - François Habersetzer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France,Institut Hospitalo Universitaire Strasbourg, Strasbourg, France,Inserm U1110, Institute for Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| |
Collapse
|
5
|
Tagliaferri AR, Estifan E, Farohkian A, Melki G, Cavanagh Y, Grossman M. A Case of a gastropancreatic fistula in the setting of intraductal papillary mucinous neoplasms. Radiol Case Rep 2022; 17:2874-2877. [PMID: 35721525 PMCID: PMC9198267 DOI: 10.1016/j.radcr.2022.05.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMN) are mucin producing tumors which arise from epithelial cells of the main pancreatic duct, pancreatic branch ducts, or both. They are characterized by mucin-producing columnar cells, papillary ductal proliferation, cyst formation, and varying degrees of dysplasia. IPMNs are classified as main duct or branch duct based upon the pancreatic duct anatomy which the IPMN is arising from. Additionally, they can be classified based on their histologic subtypes, which carry varying associations with dysplasia and/or malignancy. Many patients have incidentally identified IPMNs, which are asymptomatic. However, patients may also present with pancreatitis, elevation of liver enzymes, dilation of the pancreatic duct or bile duct as well as distention of the ampullary pancreatic orifice(s), due to impaction and obstruction with mucus. This is known as an endoscopically visualized “fish eye” sign. Patients may also develop exocrine and endocrine pancreatic insufficiency and maldigestion. Some studies also suggest that patients with IPMNs may also be at increased risk for gastric, colorectal, biliary, renal cell, and thyroid malignancies. Rarely, IPMNs can be complicated by fistulation between the main pancreatic duct and neighboring organs. Herein, we present an unusual case of simultaneous fistulation to both the gastric body and the duodenum.
Collapse
Affiliation(s)
- Ariana R Tagliaferri
- St. Joseph's University Medical Center, Department of Gastroenterology, 703 Main Street, Paterson, NJ 07503 USA
| | - Elias Estifan
- St. Joseph's University Medical Center, Department of Gastroenterology, 703 Main Street, Paterson, NJ 07503 USA
| | - Alisa Farohkian
- St. Joseph's University Medical Center, Department of Gastroenterology, 703 Main Street, Paterson, NJ 07503 USA
| | - Gabriel Melki
- St. Joseph's University Medical Center, Department of Gastroenterology, 703 Main Street, Paterson, NJ 07503 USA
| | - Yana Cavanagh
- St. Joseph's University Medical Center, Department of Gastroenterology, 703 Main Street, Paterson, NJ 07503 USA
| | - Matthew Grossman
- St. Joseph's University Medical Center, Department of Gastroenterology, 703 Main Street, Paterson, NJ 07503 USA
| |
Collapse
|
6
|
Bonin EA, Souza RCAD, Mueller RP, Ioshii SO, Ardengh JC. GASTROPANCREATIC FISTULA SECONDARY TO A PANCREATIC INTRADUCTAL PAPILLARY MUCINOUS NEOPLASIA - ENDOSCOPIC ULTRASOUND AND UPPER GASTROINTESTINAL ENDOSCOPY FINDINGS. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:262-263. [PMID: 34287535 DOI: 10.1590/s0004-2803.202100000-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Eduardo Aimore Bonin
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Curitiba, PR, Brasil
| | | | | | - Sergio Ossamu Ioshii
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Curitiba, PR, Brasil.,Pontifícia Universidade Católica do Paraná (PPGTS), Curitiba, PR, Brasil
| | - José Celso Ardengh
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brasil.,Hospital 9 de Julho, Setor de Endoscopia, São Paulo, SP, Brasil
| |
Collapse
|
7
|
Kumar M, Sonika U, Sachdeva S, Dalal A. Mucin-filled CBD, difficult to manage cholangitis. BMJ Case Rep 2021; 14:14/1/e238363. [PMID: 33431462 PMCID: PMC7802659 DOI: 10.1136/bcr-2020-238363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.
Collapse
Affiliation(s)
- Manish Kumar
- Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Ashok Dalal
- Gastroenterology, GB Pant Hospital, New Delhi, India
| |
Collapse
|
8
|
Wu J, Lin Y, Wu J. Intraductal papillary mucinous neoplasm complicated with intraductal bleeding in a young woman mimicked a cystic solid pseudo-papillary tumor: a case report. BMC Gastroenterol 2020; 20:304. [PMID: 32938404 PMCID: PMC7493377 DOI: 10.1186/s12876-020-01436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are only 6 cases of intraductal papillary mucinous neoplasm (IPMN) complicated with intraductal hemorrhage have been reported in English literatures. All these 6 cases of IPMN occurred in the old people. The present rare case of IPMN complicated with intraductal hemorrhage occurred in a young woman, and mimicked a cystic solid pseudo-papillary neoplasm (SPN) on preoperative imaging findings. CASE PRESENTATION A 29-year-old young woman complained of a sustained mild right upper quadrant abdominal pain. CT and MRI showed a lobulated, partly ill-defined cystic lesion located in the pancreatic head. Spotted calcification within cystic wall was seen on CT. The lesion was demonstrated as predominantly homogeneous hyperattenuation on CT and homogeneous high signal without decreased signal on fat suppression sequence on T1WI. After contrast administration, the cystic wall and septa of lesion was showed gradually mild to moderate degree of enhancement over time both on CT and MRI. No communication between lesion and the main duct was found on MRCP and the main pancreatic duct and common bile duct were not dilated. Considering patient's age, gender and manifestations of lesion on CT and MRI (calcification, bleeding and gradually enhanced pattern), the present case mimicked as a cystic SPN. The lesion was pathologically confirmed a branch type IPMN after surgical resection. CONCLUSION We propose that IPMN may need to be taken into account in the differential diagnosis when pancreatic cystic lesions occur in young women with bleeding, calcification, progressive enhancement of cystic wall and no communication with the main pancreatic duct.
Collapse
Affiliation(s)
- Jianman Wu
- Department of Radiology, Fujian Provincial Hospital, Provincial clinic medical college of Fujian Medical University, NO.134, Eastern Road, Gulou District, Fuzhou, China.
| | - Yin Lin
- Department of Pathology, Fujian Provincial Hospital, Provincial clinic medical college of Fujian Medical University, NO.134, Eastern Road, Gulou District, Fuzhou, China
| | - Jingwen Wu
- Department of Radiology, Fujian Provincial Hospital, Provincial clinic medical college of Fujian Medical University, NO.134, Eastern Road, Gulou District, Fuzhou, China
| |
Collapse
|
9
|
Laclau-Lacrouts M, Marichez A, Chiche L. An Intraductal Papillary Mucinous Neoplasm With Portal Thrombosis. Gastroenterology 2020; 159:42-44. [PMID: 32142777 DOI: 10.1053/j.gastro.2020.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Marie Laclau-Lacrouts
- Department of Hepatobiliary Surgery, Haut Lévêque Hospital, Centre Hospitaliser Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Arthur Marichez
- Department of Hepatobiliary Surgery, Haut Lévêque Hospital, Centre Hospitaliser Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Laurence Chiche
- Department of Hepatobiliary Surgery, Haut Lévêque Hospital, Centre Hospitaliser Universitaire (CHU) de Bordeaux, Bordeaux, France; Department of Research, INSERM UMR 1035, CHU Bordeaux, France.
| |
Collapse
|
10
|
Total Pancreatectomy for Malignant Intraductal Papillary Mucinous Neoplasm (IPMN) Complicated by Gastropancreatic Fistulae. Case Rep Surg 2020; 2020:8547526. [PMID: 32274240 PMCID: PMC7132345 DOI: 10.1155/2020/8547526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. Case Presentation. A 50-year-old female was referred for investigation of recent epigastric pain and a past history of recurrent pancreatitis. Imaging with computed tomography showed a gross dilatation of the entire pancreatic duct with a heterogeneous enhancement of the periductal parenchyma. A passage of oral contrast was noted from the greater curvature and pylorus of the stomach into the dilated duct suggestive of fistulae formation. Gastroduodenoscopy demonstrated these fistulae in the stomach and the proximal duodenum and an exophytic growth at the ampulla obliterating the view of ampullary opening. Endosonography- (EUS-) guided fine-needle aspiration cytology (FNAC) showed cells with high-grade atypia. A total pancreatectomy, distal gastrectomy, and splenectomy were performed, and recovery was uneventful. Histology revealed a ductal adenocarcinoma arising from an intestinal type intraductal papillary mucinous neoplasm with high-grade dysplasia. A year and a half after surgery, she is healthy with good glycaemic control and nutritional status. Conclusion This case highlights the importance investigating patients for the aetiology in recurrent acute pancreatitis and their follow-up. Awareness of cystic pancreatic neoplasms including IPMN is important to avoid misdiagnosis or delayed diagnosis. Referral of these patients to centres with facilities for multidisciplinary input and specialised management is strongly recommended.
Collapse
|
11
|
Khneizer G, Reddy KM, Hammami MB, Alkaade S. Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis. Gastroenterology Res 2019; 12:43-47. [PMID: 30834035 PMCID: PMC6396797 DOI: 10.14740/gr1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 11/29/2022] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are characterized by proliferation of mucin-secreting cells in the main pancreatic duct (PD) or its branches. The secreted thick mucin usually leads to PD obstruction and dilation. A common complication of IPMN is recurrent acute pancreatitis secondary to poor pancreatic fluid drainage, and rarely, pancreatobiliary and pancreatointestinal fistulae. We describe a unique case of IPMN in a 57-year-old male who was referred to our institution for evaluation of recurrent acute pancreatitis. After extensive evaluation, he was diagnosed with main duct IPMN. Intraductal PD biopsy revealed intestinal type IPMN with intermediate grade dysplasia. Patient was managed clinically by large caliber (10 French) PD stenting which eliminated his recurrent acute pancreatitis. The patient was initially referred for pancreatic resection; however, surgery was aborted and evaluated to be high risk with high morbidity secondary to the extensive adhesions between the pancreas and surrounding structures. Patient remained clinically stable for a few years except for an episode of acute pancreatitis that happened after a trial of stent removal. Subsequently, the patient did well after the PD stent was replaced. Recently, repeat abdominal imaging revealed a large pancreatoduodenal fistula which was confirmed on repeat endoscopic retrograde cholangiopancreatography. We were able to perform pancreatoscopy by advancing a regular upper scope through the fistula and into the PD. Interestingly, the fistula relieved the symptoms of obstruction and subsequently decreased the frequency of recurrent pancreatitis episodes with no further episodes at 6 months follow-up. This case highlights the importance of providing adequate PD drainage to reduce the frequency of recurrent acute pancreatitis in the setting of main duct IPMN, especially if the patient is not a surgical candidate. Also, physicians need to monitor for complications such as fistula formation between the pancreas and surrounding structures in the setting of chronic inflammation due to recurrent episodes of pancreatitis. Early identification of a fistula is important for surgical planning. Furthermore, since recent studies suggested a higher incidence of additional primary malignancies in patients with IPMN of the pancreas compared to the general population, patients may be considered for screening for other primary malignancies.
Collapse
Affiliation(s)
- Gebran Khneizer
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kavya M Reddy
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Muhammad B Hammami
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Samer Alkaade
- Saint Louis University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
12
|
Ren X, Zhu CL, Qin XF, Jiang H, Xia T, Qu YP. Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature. World J Clin Cases 2019; 7:102-108. [PMID: 30637259 PMCID: PMC6327132 DOI: 10.12998/wjcc.v7.i1.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is pathologically similar to intraductal papillary mucinous neoplasm (IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.
CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month follow-up period.
CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.
Collapse
Affiliation(s)
- Xu Ren
- Digestive Disease Hospital of Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Province, China
| | - Chun-Lan Zhu
- The Second Digestive Department, Digestive Disease Hospital of Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Provice, China
| | - Xu-Fu Qin
- The Second Digestive Department, Digestive Disease Hospital of Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Provice, China
| | - Hong Jiang
- Department of Pathology of Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Provice, China
| | - Tian Xia
- Digestive Disease Hospital of Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Province, China
| | - Yong-Ping Qu
- Digestive Endoscopy Center, Digestive Disease Hospital of Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Provice, China
| |
Collapse
|
13
|
Patel A, Allen A, Kuwahara J, Wadsworth T, Loeffler DM, Xie KL. Intraductal papillary mucinous neoplasm complicated by a gastropancreatic fistula. Radiol Case Rep 2018; 14:320-323. [PMID: 30546816 PMCID: PMC6289956 DOI: 10.1016/j.radcr.2018.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/17/2018] [Accepted: 11/25/2018] [Indexed: 01/05/2023] Open
Abstract
One of the rare complications of low-grade pancreatic neoplasms is fistulization into nearby structures. This often does not present clinically, but is incidentally identified in patients who have been imaged serially to monitor the progression of the disease. In this report, we present an uncommon complication of an intraductal papillary mucinous neoplasm, which developed a spontaneous gastropancreatic fistula in a patient who was conservatively managed. The clinical course, imaging features, and management of this case are discussed.
Collapse
Affiliation(s)
| | - Amanda Allen
- University of Illinois at Chicago, Department of Pathology, Chicago, IL, USA
| | | | - Tracy Wadsworth
- University of Illinois at Chicago, Department of Pathology, Chicago, IL, USA
| | - David M Loeffler
- University of Illinois at Chicago, Department of Pathology, Chicago, IL, USA
| | - Karen L Xie
- University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
14
|
Komo T, Oishi K, Kohashi T, Hihara J, Kanou M, Nakashima A, Kaneko M, Mukaida H, Hirabayashi N. Pancreatobiliary fistula associated with intraductal papillary mucinous carcinoma accompanying obstructive jaundice: A case report. Int J Surg Case Rep 2018; 48:126-130. [PMID: 29890488 PMCID: PMC6035910 DOI: 10.1016/j.ijscr.2018.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/20/2018] [Accepted: 05/25/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Intraductal papillary mucinous neoplasms (IPMNs) occasionally involve formation of fistulas with other adjacent organs. Pancreatobiliary fistulas associated with IPMNs are rare, but affected patients often develop obstructive jaundice and cholangitis. PRESENTATION OF CASE A 79-year-old man was referred to our hospital for evaluation of abnormal biliary enzymes. Contrast-enhanced computed tomography and endoscopic retrograde cholangiopancreatography demonstrated multiple cystic lesions with septa in the pancreatic head and fistulas between the cystic lesions and common bile duct. The clinical diagnosis was pancreatobiliary fistula associated with a mixed-type IPMN and accompanying obstructive jaundice. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. The resected specimen showed fistulas between the cystic lesions and common bile duct. Histopathological examination showed that the main and branch ducts of the pancreatic head were dilated and filled with mucus. The epithelia of the pancreatic ducts revealed papillary proliferation and an invasive adenocarcinoma arising from an intraductal neoplasm. Immunohistochemistry examination showed CDX2- and MUC2-positive reactions. The final diagnosis was an intraductal papillary mucinous carcinoma of the intestinal-type. The patient remained disease-free for 9 months postoperatively. DISCUSSION The causes of death in patients who have pancreatobiliary fistulas associated with IPMNs without resection are cholangitis or hepatic insufficiency. Nonoperative treatment is limited for cases with obstructive jaundice. It is necessary to prevent obstructive jaundice and cholangitis due to a large quantity of mucinous material. CONCLUSIONS Surgical resection should be considered, if possible, in patients with pancreatobiliary fistulas associated with IPMNs. A better prognosis is expected with prevention of obstructive jaundice or cholangitis.
Collapse
Affiliation(s)
- Toshiaki Komo
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Koichi Oishi
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan.
| | - Toshihiko Kohashi
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute Biomedical & Health Sciences, Hiroshima University, Japan
| | - Jun Hihara
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Mikihiro Kanou
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Akira Nakashima
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Japan
| | - Hidenori Mukaida
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Naoki Hirabayashi
- Department of Gastroenterological Surgery, Hiroshima City Asa Citizens Hospital, Japan
| |
Collapse
|
15
|
Cortegoso Valdivia P, Bruno M, Gaia S, Saracco GM, De Angelis C. A rare case of gastric fistulization of a main-duct intraductal papillary mucinous neoplasm. MINERVA GASTROENTERO 2018; 64:383-385. [PMID: 29553226 DOI: 10.23736/s1121-421x.18.02486-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a rare case of gastric fistulization in a patient with main-duct (MD) intraductal papillary mucinous neoplasm (IPMN). Fistulization to adjacent organs is a rare complication of this disease, mainly affecting the duodenum; the fact that the stomach was the only organ involved makes this case even more peculiar. The diagnosis of the fistula was made after examination with endoscopic ultrasound, since a previous computed tomography scan could not detect it.
Collapse
Affiliation(s)
- Pablo Cortegoso Valdivia
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Mauro Bruno
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Silvia Gaia
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Claudio De Angelis
- Department of Gastroenterology and Digestive Endoscopy, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| |
Collapse
|
16
|
Heneidy H, Yosef W, Badr S. Cystic pancreatic lesions; CT characterization and pathological evaluation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
17
|
Maubert A, Vanbiervliet G, Benizri EI. Pancreatico-gastric fistula complicating an intraductal papillary mucinous neoplasm. J Visc Surg 2017; 154:137-138. [PMID: 28363769 DOI: 10.1016/j.jviscsurg.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Fistula as a complication of pancreatic intraductal papillary mucinous neoplasms (IPMN) is rare and may involve different adjacent organs, sometimes, several organs at the same time. Our patient had a pancreatico-gastric fistula, discovered at work-up for IPMN, which required extensive surgery.
Collapse
Affiliation(s)
- A Maubert
- Service de chirurgie générale et cancérologie digestive, hôpital de l'Archet 2, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine de Ginestière, B.P. 3079, 06200 Nice cedex 3, France.
| | - G Vanbiervliet
- Service de gastro-entérologie, hôpital de l'Archet 2, centre hospitalier universitaire de Nice, 06200 Nice, France
| | - E I Benizri
- Service de chirurgie générale et cancérologie digestive, hôpital de l'Archet 2, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine de Ginestière, B.P. 3079, 06200 Nice cedex 3, France
| |
Collapse
|