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• W2977776165 abstract "Purpose: Background: Fistula formation is an uncommon complication of pancreatic pseudocysts. Unique and even rarer are fistulas draining into the biliary tract. We present such a case with a review of literature. Case: A 52-year old woman with non-alcoholic recurrent acute pancreatitis and previous cholecystectomy was admitted for radiating epigastric pain, nausea, vomiting, anorexia and fever. On admission, she had a lipase of 557 U/L and WBC of 11.3 K/μL. Abdominal CT showed non-necrotizing pancreatitis with a large intra-pancreatic pseudocyst. MRCP confirmed the pseudocyst measuring 17.2x4.7 cm and a dilated CBD measuring 8 mm with no choledocholithiasis. She was discharged improved after medical management. Four weeks later, she developed progressive jaundice. Outpatient workup revealed elevated total bilirubin 6.4 mg/dL, AST 88 U/L, ALT 159 U/L, and alkaline phosphatase 509 U/L. ERCP showed a severely dilated distal CBD impacted with sludge and a fistula connecting the pseudocyst to the CBD. Sphincterotomy was done to remove the purulent sludge from the CBD, after which a 10-French 7-cm straight stent was placed across the papilla to facilitate further drainage. Her jaundice and transaminase levels significantly improved post-ERCP. Two months later, repeat ERCP showed only a mildly dilated CBD with complete resolution of the fistula. Unobstructed biliary flow prompted the removal of the CBD stent. Discussion: Pancreatic pseudocysts more commonly fistulize to the stomach, duodenum, and colon but very rarely to the CBD. In our review of the literature, we found only 17 case reports describing such pathology. Majority of them involved male patients with chronic alcoholic pancreatitis. Pseudocyst drainage was accomplished through duodenal or jejunal surgical ostomy in 10 patients, while external drainage was performed in 2 patients. Endoscopically placed stents across the ampulla and connecting the pseudocyst to the CBD provided effective drainage in 3 patients. Our case is unique in that her recurrent pancreatitis was probably due to chronic cholecystitis resulting from biliary sludge or microlithiasis as confirmed by the absence of stones from her post-cholecystectomy pathology findings. Her CBD became obstructed after the fistulous connection was formed due to progressive inflammatory reaction to the pseudocyst enzyme-rich fluid. Treatment of our patient is also unique because CBD stenting was sufficient for biliary decompression and drainage of the pseudocyst contents. Repeat ERCP confirmed a resolved pseudocyst and a healed fistula." @default.
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• W2977776165 date "2011-10-01" @default.
• W2977776165 modified "2023-09-25" @default.
• W2977776165 title "Fistulous Communication of a Pancreatic Pseudocyst to the CBD - A Case Report and Review of Literature" @default.
• W2977776165 doi "https://doi.org/10.14309/00000434-201110002-00592" @default.
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