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• W2043488406 abstract "Background85 year old male presented with acute pancreatitis. CT imaging of the abdomen revealed severe dilation of a markedly irregular pancreatic duct with possible fistulous communication with both the stomach and duodenum. A multi-modality approach was used to achieve a diagnosis of a rare clinical entity.Endoscopic methodsUpper endoscopy defined the luminal orifaces of simultaneous pancreatico-gastric and pancreatico-duodenal fistulae. Direct pancreatoscopy was able to be performed with a 11.3 mm therapeutic videoendoscope via intubation of the pancreatico-duodenal fistula. Endoscopic ultrasound was used to image the fistulae; EUS also identified a third, pancreatico-biliary fistula. ERCP confirmed EUS findings and also allowed for extraction of biliary mucin in the clincal setting of obstructive jaundice.Clinical implicationsWe present a rare case of IPMN with simultaneous multi-organ fistulization. In this case the fistulization occurred by mechanical penetration in the absence of malignant transformation. IPMN fistulization has been described, although it is a rare clinical entity. There have been very few reported cases of multi-organ fistulization. We demonstrated a multi-modality approach to diagnosis using direct pancreatoscopy, EUS, and ERCP. Background85 year old male presented with acute pancreatitis. CT imaging of the abdomen revealed severe dilation of a markedly irregular pancreatic duct with possible fistulous communication with both the stomach and duodenum. A multi-modality approach was used to achieve a diagnosis of a rare clinical entity. 85 year old male presented with acute pancreatitis. CT imaging of the abdomen revealed severe dilation of a markedly irregular pancreatic duct with possible fistulous communication with both the stomach and duodenum. A multi-modality approach was used to achieve a diagnosis of a rare clinical entity. Endoscopic methodsUpper endoscopy defined the luminal orifaces of simultaneous pancreatico-gastric and pancreatico-duodenal fistulae. Direct pancreatoscopy was able to be performed with a 11.3 mm therapeutic videoendoscope via intubation of the pancreatico-duodenal fistula. Endoscopic ultrasound was used to image the fistulae; EUS also identified a third, pancreatico-biliary fistula. ERCP confirmed EUS findings and also allowed for extraction of biliary mucin in the clincal setting of obstructive jaundice. Upper endoscopy defined the luminal orifaces of simultaneous pancreatico-gastric and pancreatico-duodenal fistulae. Direct pancreatoscopy was able to be performed with a 11.3 mm therapeutic videoendoscope via intubation of the pancreatico-duodenal fistula. Endoscopic ultrasound was used to image the fistulae; EUS also identified a third, pancreatico-biliary fistula. ERCP confirmed EUS findings and also allowed for extraction of biliary mucin in the clincal setting of obstructive jaundice. Clinical implicationsWe present a rare case of IPMN with simultaneous multi-organ fistulization. In this case the fistulization occurred by mechanical penetration in the absence of malignant transformation. IPMN fistulization has been described, although it is a rare clinical entity. There have been very few reported cases of multi-organ fistulization. We demonstrated a multi-modality approach to diagnosis using direct pancreatoscopy, EUS, and ERCP. We present a rare case of IPMN with simultaneous multi-organ fistulization. In this case the fistulization occurred by mechanical penetration in the absence of malignant transformation. IPMN fistulization has been described, although it is a rare clinical entity. There have been very few reported cases of multi-organ fistulization. We demonstrated a multi-modality approach to diagnosis using direct pancreatoscopy, EUS, and ERCP." @default.
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• W2043488406 date "2011-04-01" @default.
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• W2043488406 title "Sp702 Intraductal Papullary Mucinous Neoplasm of the Pancreas with Multi-Organ Fistulization" @default.
• W2043488406 doi "https://doi.org/10.1016/j.gie.2011.03.1220" @default.
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