Clinical Course and Diagnostic Features of Pancreatic–Portal Venous Fistula: A Case Report
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16614Keywords:
acute pancreatitis, pancreatic pseudocyst, pancreatic pseudocyst–portal vein fistula, portal vein thrombosis, hepatic fluid collectionAbstract
The aim of the work: to present a clinical case of pancreatic pseudocyst complicated by fistula formation into the portal vein, chronic portal venous thrombosis, and development of intrahepatic pancreatic fluid collections.
Materials and Methods. We report a clinical case of a 33-year-old female patient with a complicated course of acute pancreatitis. Diagnostic evaluation included clinical and laboratory assessment, abdominal ultrasonography, and contrast-enhanced computed tomography of the abdominal cavity.
Results. Examination revealed a pancreatic body pseudocyst, fistulous communication between the cystic lesion and the thrombosed portal vein, cavernous transformation of the portal venous system, and large fluid collections within the right hepatic lobe. Ultrasound-guided percutaneous drainage of the hepatic collections was performed with evacuation of up to 3000 mL of hemorrhagic-chylous fluid characterized by elevated amylase levels. The patient demonstrated favorable clinical and laboratory improvement following treatment.
Conclusions. Pancreatic pseudocyst–portal venous fistula (PPVF) is a rare complication of pancreatitis that may be associated with portal vein thrombosis and atypical intrahepatic pancreatic fluid collections. Contrast-enhanced computed tomography plays a key role in the diagnosis of this pathological condition, while minimally invasive drainage techniques may represent an effective treatment strategy.
References
1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62(1):102-111. DOI: 10.1136/gutjnl-2012-302779. DOI: https://doi.org/10.1136/gutjnl-2012-302779
2. Demeusy A, Hosseini M, Sill AM, Cunningham SC. Intrahepatic pancreatic pseudocyst: A review of the world literature. World J Hepatol. 2016; 8(35): 1576-83. DOI: 10.4254/wjh.v8.i35.1576. DOI: https://doi.org/10.4254/wjh.v8.i35.1576
3. Horino K, Takamori H, Ikuta Y, Chikamoto A, Ishiko T, Beppu T, et al. Pancreatic pseudocyst-portal vein fistula. Open Journal of Gastroenterology. 2012; 2(3):143-44. DOI: 10.4236/ojgas. 2012.23028.
4. Makary MS, Gayou EL, Kyrouac D, Shah ZK. Pancreaticoportal fistula formation as a consequence of recurrent acute pancreatitis: clinical and imaging considerations. J Clin Imaging Sci. 2018; 8:4. DOI: 10.4103/jcis.JCIS_84_17. DOI: https://doi.org/10.4103/jcis.JCIS_84_17
5. Griffin NE, Ferrell M, Feldman R, Dasyam AK, Slivka A, Khalid A, et al. Natural history of spontaneous pancreatic portal vein fistulae: a systematic review of the literature. Pancreatology. 2024; 24(6):870-77. DOI: 10.1016/j.pan.2024.07.016. DOI: https://doi.org/10.1016/j.pan.2024.07.016
6. Eccles J, Wiebe E, D'Souza P, Sandha G. Pancreatic pseudocyst-portal vein fistula with refractory hepatic pseudocyst: two cases treated with EUS cyst-gastrostomy and review of the literature. Endosc Int Open. 2019; 7(1):E83-E86. DOI: 10.1055/a-0754-2247. DOI: https://doi.org/10.1055/a-0754-2247
7. Das P, Thakur D, Borah GJ, Wodeyar NK, Balankhe K, Kumar SR, et al. Pseudocyst-portal vein fistula with hepatic pseudocysts as life-threatening complication of pancreatitis: a case series with review of literature. Journal of Digestive Endoscopy. 2024; 15(04):228-34. DOI: 10.1055/s-0044-1792132. DOI: https://doi.org/10.1055/s-0044-1792132
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ігор Дужий, Сергій Метинський, Олександр Курочкін, Віталій Логутов, Юрій Ярошенко, Юлія Шаповал
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
