[A case of intraductal papillary mucinous neoplasm with internal pancreatic fistula causing left ureteral obstruction].
A 75-year-old man had been admitted to another hospital because of left abdominal pain, and was given a diagnosis of left hydronephrosis and acute pancreatitis. After a JJ stent insertion and medication, he was transferred to our hospital for further examinations. US and EUS revealed a chronic pancreatitis-like pattern and multicystic lesion in the pancreas head and body. At that time enhanced CT findings showed an extrapancreatic low density area to be inflammatory change, extending from the pancreas body to the left crus of the diaphragm and posteriorly the spreading from the left crus of the diaphragm via the left urinary duct into the left iliopsoas muscle, in which MRI revealed partial high intensity. ERCP and MRCP showed focal irregular narrowing of the pancreatic duct of unknown cause, and we decided that an internal pancreatic fistula due to pancreatitis had induced left ureteral obstruction, caused by a protein plug or alcohol. Follow-up 6 months later showed that extrapancreatic spreading of the low density area had markedly regressed without any change in the ureteral obstruction.
Takahashi
Sho
S
Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine.
Homma
Hisato
H
Akiyama
Takehide
T
Mesawa
Shinichi
S
Hirata
Kenichiro
K
Kogawa
Katsuhisa
K
Takanashi
Kunihiro
K
Ishiwatari
Hirotoshi
H
Kawano
Yutaka
Y
Hayashi
Tsuyoshi
T
Takada
Kohichi
K
Miyanishi
Koji
K
Kato
Junji
J
Niitsu
Yoshiro
Y
D000208:Acute Disease; D002288:Adenocarcinoma, Mucinous / Q000150:complications*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications*; D006801:Humans; D008297:Male; D010185:Pancreatic Fistula / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications*; D010195:Pancreatitis / Q000150:complications; D014517:Ureteral Obstruction / Q000209:etiology*