Shifting the Treatment Paradigm for Pancreaticoportal Fistula Causing Hepatic Necrosis

  • Lauren M. Perry
  • Thomas Loehfelm
  • Rex Pillai
  • Dana Y. Pan
  • Sooraj Tejaswi
  • Sepideh GholamiEmail author
Stanford Multidisciplinary Seminars

Case Presentation and Evolution

A 50-year-old woman was evaluated in the primary care clinic with yellowing of the eyes 2 months after hospitalization for acute pancreatitis complicated by E. coli sepsis. Laboratory evaluation revealed elevated total bilirubin (3.4 mg/dl; normal 0.3–1.3), alkaline phosphatase (891 U/L; normal 35–115), aspartate transaminase (94 U/L; normal 15–43), and alanine aminotransferase (103 U/L; normal 5–54).

Abdominal ultrasound demonstrated a 3.5-cm hypoechoic avascular mass in the head of the pancreas (Fig.  1). Although the portal vein had anechoic contents, interrogation with color and spectral Doppler revealed a complete absence of blood flow throughout the portal system (Fig.  1). Computed tomography (CT) identified the mass as a pseudocyst related to her recent pancreatitis (Fig.  2). The pseudocyst externally compressed the common bile duct with resultant intrahepatic and extrahepatic biliary ductal dilatation proximal to this level. The portal vein had...


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Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Lauren M. Perry
    • 1
  • Thomas Loehfelm
    • 2
  • Rex Pillai
    • 3
  • Dana Y. Pan
    • 4
  • Sooraj Tejaswi
    • 4
  • Sepideh Gholami
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of CaliforniaDavis, SacramentoUSA
  2. 2.Division of Abdominal Imaging, Department of RadiologyUniversity of CaliforniaDavisUSA
  3. 3.Division of Interventional Radiology, Department of RadiologyUniversity of CaliforniaDavisUSA
  4. 4.Division of Gastroenterology, Department of Internal MedicineUniversity of CaliforniaDavisUSA

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