[Endoscopic treatment of subcutaneous fat necrosis secondary to pancreatic-vascular fistula: apropos of a case].
METHODS
We report the case of a 68-year-old man who presented a pancreatic tumor with a pancreato-vascular fistula and a Weber-Christian syndrome. Pancreatic enzymes levels at the admission were high: amylasemia 2,470 IU/L (N < 110) and lipasemia 11,700 IU/L (N < 220). The treatment consisted in total parenteral nutrition and somatostatin (100 micrograms x 3/day). Because we noted neither clinical nor biological improvement after 10 days of treatment, we performed an endoscopic retrograde pancreatography. During this examination, we put a 7 French diameter prosthesis through the Wirsung stenosis.


RESULTS
No problem arose after endoscopy: since the day after the endoscopy, pancreatic enzymes decreased by half and become normal in 4 days; arthralgias and cutaneous injuries, both caused by cytosteatonecrosis, disappeared respectively in 5 and 10 days. There is no evidence of subsequent recurrence after 3 months of follow-up.


CONCLUSIONS
Pancreatic endoscopic prosthesis can replace the surgical treatment of pancreato-vascular fistula with a good efficacy.
Service de médecine interne, pavillon Dieulafoy, CHU Purpan, place du Docteur-Baylac, Toulouse, France.
D
D
Reynaud
L
L
Alric
J
J
Escourrou
E
E
Bonnet
M
M
Duffaut
D000368:Aged; D000681:Amylases / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004796:Clinical Enzyme Tests; D003251:Constriction, Pathologic / Q000628:therapy; D004724:Endoscopy; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010201:Panniculitis, Nodular Nonsuppurative / Q000209:etiology* / Q000628:therapy; D019919:Prosthesis Implantation; D016157:Vascular Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014682:Vena Cava, Inferior
D000681:Amylases
Traitement endoscopique d'une cytostéatonécrose secondaire à une fistule pancréaticovasculaire: à propos d'un cas.