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

  • Kosuke Sato
  • Kazuya TakahashiEmail author
  • Yukio Aruga
  • Fusako Yamazaki
  • Daisuke Kumaki
  • Masashi Yamakawa
  • Masaaki Hirano
  • Kazuhiro Funakoshi
  • Shuji Terai
Case Report
  • 19 Downloads

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.

Keywords

Pancreatic pseudocyst Infection Pseudocystocolonic fistula Pseudoaneurysm 

Notes

Acknowledgements

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

Author 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.

Funding

No funding to disclose.

Compliance with ethical standards

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.

References

  1. 1.
    Sarr MG. 2012 revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn. 2013;123:118–24.Google Scholar
  2. 2.
    Baillie J. Pancreatic pseudocysts (Part I). Gastrointest Endosc. 2004;59:873–9.CrossRefGoogle Scholar
  3. 3.
    Ramsey ML, Conwell DL, Hart PA. Complications of chronic pancreatitis. Dig Dis Sci. 2017;62:1745–50.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 5.
    Agalianos C, Passas I, Sideris I, et al. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol. 2018;3:18.CrossRefGoogle Scholar
  6. 6.
    Andrén-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part II: Natural history. JOP. 2004;5:64–70.Google Scholar
  7. 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.CrossRefGoogle Scholar
  8. 8.
    Wiersema MJ. Endosonography-guided cystoduodenostomy with a therapeutic ultrasound endoscope. Gastrointest Endosc. 1996;44:614–7.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 11.
    Subtil Iñigo JC, Muñoz-Navas M. Endoscopic ultrasonographic drainage of pancreatic fluid collections. Interv Ther Gastrointest Endosc. 2009;27:485–500.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 16.
    Chiang KC, Chen TH, Te Hsu J. Management of chronic pancreatitis complicated with a bleeding pseudoaneurysm. World J Gastroenterol. 2014;20:16132–7.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 22.
    Shatney CH, Sosin H. Spontaneous perforation of a pancreatic pseudocyst into the colon and duodenum. Am J Surg. 1973;126:433–8.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 24.
    Karvonen J, Gullichsen R, Salminen P, et al. Endoscopic treatment of pseudocystocolonic fistula with fibrin glue. Gastrointest Endosc. 2010;72:664–5.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineNiigata Prefectural Central HospitalJoetsuJapan
  2. 2.Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan

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