title: Pancreatic pseudocystportal vein fistula manifests as residivating oligoarthritis, subcutaneous, bursal and osseal necrosis: a case report and review of literature.
abstract: Pseudocyst is a common complication of pancreatitis. Pseudocyst may rupture into the surrounding organs. Rupture into the portomesenteric vein is extremely rare with only seven cases being described in the English literature. pancreatic portal vein fistula is very difficult to verify. The aim of this study was to view the diagnostic methods of pancreatic portal vein fistula and to describe the results of high-dose corticosteroid treatment to our knowledge for the first time. We report here a case of pancreatic portomesenteric vein fistula that was manifest as subcutaneous fat necrosis, bursal necrosis, intramedullary aseptic bone necrosis and recidivating oligoarthritis. The literature of this unusual complication is reviewed. The results of high-dose corticosteroid treatment are also described. In patients with recidivating oligoarthritis, subcutaneous, bursal or osseal necrosis a pancreatic process should be included in the differential diagnosis even in cases of no abdominal signs or symptoms or previous abdominal history. Operative exploration of the pancreas should be performed in the early phase of the disease. To diminish the ongoing extrapancreatic manifestations after the closure of the fistula massive corticosteroid treatment may be attempted although the role of this therapy remains controversial.
authors.affiliation: Department of Surgery, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland. anne-marja.hammar@tt.tampere.ti
authors.forename: Anne-Marja
authors.initials: AM
authors.lastname: Hammar
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
authors.forename: Jukka
authors.initials: J
authors.lastname: Lumio
authors.forename: Martti
authors.initials: M
authors.lastname: Hirn
authors.forename: Seppo
authors.initials: S
authors.lastname: Honkonen
authors.forename: Liisa
authors.initials: L
authors.lastname: Tuominen
authors.forename: Isto
authors.initials: I
authors.lastname: Nordback
mesh_terms: D000328:Adult; D000681:Amylases / Q000097:blood; D001168:Arthritis / Q000628:therapy; D002061:Bursa, Synovial / Q000473:pathology; D002097:C-Reactive Protein / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005218:Fat Necrosis / Q000628:therapy; D006801:Humans; D008297:Male; D009336:Necrosis; D010020:Osteonecrosis / Q000628:therapy; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000628:therapy*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis* / Q000628:therapy*; D011169:Portal Vein; D013514:Surgical Procedures, Operative / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D002097:C-Reactive Protein; D000681:Amylases