Skip to main content

Advertisement

SpringerLink
Log in

A case of pancreatic pseudocysts accompanied by infection, pseudoaneurysm ruptures, and pseudocystocolonic fistulae

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Pancreatic pseudocysts (PPs) can be accompanied by infection, pseudoaneurysm ruptures, and fistulae to other organs, which can be fatal without appropriate treatment. Herein, we present the case of an 82-year-old man with PPs accompanied by infection, pseudoaneurysm rupture, and pseudocystocolonic fistula that were managed via multidisciplinary treatment. Computed tomography (CT) revealed two inflamed PPs, one each in the pancreatic head and tail. He was, therefore, diagnosed with infectious PPs. The pancreatic head PP shrunk on endoscopic nasopancreatic drainage (ENPD), but the pancreatic tail PP did not. Endoscopic ultrasound (EUS)-guided transluminal drainage was performed to treat the pancreatic tail PP; his symptoms improved. However, he vomited blood at 14 day post-drainage. Angiography revealed pseudoaneurysm rupture in a left gastric artery branch. After successful angioembolization, he developed hematochezia 2 days later. We suspected re-bleeding of the pseudoaneurysm. The bleeding stopped spontaneously, but CT and radiography revealed the presence of a pseudocystocolonic fistula. Careful follow-up was performed, and he has not had any symptoms at 9 month post-discharge. We managed PP-related complications via ENPD, EUS-guided transluminal drainage, angioembolization, and careful follow-up. Infection, pseudoaneurysm rupture, and pseudocystocolonic fistula are rare, but can occur simultaneously. Therefore, clinicians should consider these complications when treating patients with PPs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Sarr MG. 2012 revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn. 2013;123:118–24.

    PubMed  Google Scholar 

  2. Baillie J. Pancreatic pseudocysts (Part I). Gastrointest Endosc. 2004;59:873–9.

    Article  Google Scholar 

  3. Ramsey ML, Conwell DL, Hart PA. Complications of chronic pancreatitis. Dig Dis Sci. 2017;62:1745–50.

    Article  Google Scholar 

  4. Tan J, Zhou L, Cao R, et al. Identification of risk factors for pancreatic pseudocysts formation, intervention and recurrence: a 15-year retrospective analysis in a tertiary hospital in China. BMC Gastroenterol. 2018;18:143.

    Article  Google Scholar 

  5. Agalianos C, Passas I, Sideris I, et al. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol. 2018;3:18.

    Article  Google Scholar 

  6. Andrén-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part II: Natural history. JOP. 2004;5:64–70.

    PubMed  Google Scholar 

  7. Melman L, Azar R, Beddow K, et al. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Surg Endosc. 2009;23:267–71.

    Article  Google Scholar 

  8. Wiersema MJ. Endosonography-guided cystoduodenostomy with a therapeutic ultrasound endoscope. Gastrointest Endosc. 1996;44:614–7.

    Article  CAS  Google Scholar 

  9. Azar RR, Oh YS, Janec EM, et al. Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope. Gastrointest Endosc. 2006;63:688–92.

    Article  Google Scholar 

  10. Varadarajulu S, Wilcox CM, Tamhane A, et al. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc. 2007;66:1107–19.

    Article  Google Scholar 

  11. Subtil Iñigo JC, Muñoz-Navas M. Endoscopic ultrasonographic drainage of pancreatic fluid collections. Interv Ther Gastrointest Endosc. 2009;27:485–500.

    Article  Google Scholar 

  12. Tyberg A, Karia K, Gabr M, et al. Management of pancreatic fluid collections: a comprehensive review of the literature. World J Gastroenterol. 2016;22:2256–70.

    Article  CAS  Google Scholar 

  13. Sadik R, Kalaitzakis E, Thune A, et al. EUS-guided drainage is more successful in pancreatic pseudocysts compared with abscesses. World J Gastroenterol. 2011;17:499–505.

    Article  Google Scholar 

  14. Varadarajulu S, Bang JY, Phadnis MA, et al. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg. 2011;15:2080–8.

    Article  Google Scholar 

  15. Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68:1102–11.

    Article  Google Scholar 

  16. Chiang KC, Chen TH, Te Hsu J. Management of chronic pancreatitis complicated with a bleeding pseudoaneurysm. World J Gastroenterol. 2014;20:16132–7.

    Article  Google Scholar 

  17. Udd M, Leppäniemi AK, Bidel S, et al. Treatment of bleeding pseudoaneurysms in patients with chronic pancreatitis. World J Surg. 2007;31:504–10.

    Article  Google Scholar 

  18. Carr JA, Cho JS, Shepard AD, et al. Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg. 2000;32:722–30.

    Article  CAS  Google Scholar 

  19. Cui B, Zhou L, Khan S, et al. Role of enteral nutrition in pancreaticocolonic fistulas secondary to severe acute pancreatitis: a case report. Medicine (Baltimore). 2017;96:e9054.

    Article  Google Scholar 

  20. Kwon JC, Kim BY, Kim AL, et al. Pancreatic pseudocystocolonic fistula treated without surgical or endoscopic intervention. World J Gastroenterol. 2014;20:1882–6.

    Article  Google Scholar 

  21. Suzuki A, Suzuki S, Sakaguchi T, et al. Colonic fistula associated with severe acute pancreatitis: report of two cases. Surg Today. 2008;38:178–83.

    Article  Google Scholar 

  22. Shatney CH, Sosin H. Spontaneous perforation of a pancreatic pseudocyst into the colon and duodenum. Am J Surg. 1973;126:433–8.

    Article  CAS  Google Scholar 

  23. Will U, Meyer F, Hartmeier S, et al. Endoscopic treatment of a pseudocystocolonic fistula by band ligation and endoloop application: case report. Gastrointest Endosc. 2004;59:581–3.

    Article  Google Scholar 

  24. Karvonen J, Gullichsen R, Salminen P, et al. Endoscopic treatment of pseudocystocolonic fistula with fibrin glue. Gastrointest Endosc. 2010;72:664–5.

    Article  Google Scholar 

  25. Koike Y, Kudo T, Shigesawa T, et al. Pancreatic pseudocyst with complicating colonic fistula successfully closed using the over-the-scope-clip system. Endoscopy. 2014;46:178–9.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Dr. Yoshinori Kihara and Dr. Yuzuru Okuizumi in the department of radiology, Niigata Prefectural Central Hospital for a technical support.

Funding

No funding to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu, Niigata, 943-0192, Japan

    Kosuke Sato, Kazuya Takahashi, Yukio Aruga, Fusako Yamazaki, Daisuke Kumaki, Masashi Yamakawa, Masaaki Hirano & Kazuhiro Funakoshi

  2. Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

    Kazuya Takahashi & Shuji Terai

Authors
  1. Kosuke Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuya Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yukio Aruga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fusako Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daisuke Kumaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masashi Yamakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaaki Hirano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuhiro Funakoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shuji Terai
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drafting of the paper: KS; critical revision of the manuscript: KT; revision of the manuscript: YA and ST; and technical support: FY, DK, MY, MH, and KF.

Corresponding author

Correspondence to Kazuya Takahashi.

Ethics declarations

Conflict of interest

None of the authors have a conflict of interest.

Human/animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Ethics approval

Ethical approval was not required.

Informed consent

Written informed consent was obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sato, K., Takahashi, K., Aruga, Y. et al. A case of pancreatic pseudocysts accompanied by infection, pseudoaneurysm ruptures, and pseudocystocolonic fistulae. Clin J Gastroenterol 12, 615–620 (2019). https://doi.org/10.1007/s12328-019-00986-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-019-00986-8

Keywords

Search

Navigation