title: Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: report of a case.
abstract: We report a pancreatobiliary fistula caused by an intraductal papillary-mucinous pancreatic neoplasm (IPMN), manifesting as obstructive jaundice. Computed tomography showed dilatation of the bile duct and main pancreatic duct, with multiple cystic masses in the head of the pancreas. Endoscopic retrograde pancreatocholangiography showed a patulous papilla with mucin secretion. Contrast enhancement outlined amorphous material obstructing the lower part of the common hepatic duct. Pancreatogram and magnetic resonance cholangiopancreatography showed diffuse dilatation of the main pancreatic duct and side branches without communication with the adjacent organs or duct. We performed pancreaticoduodenectomy for IPMN of the pancreatic head and a tumor-like lesion in the lower common bile duct (CBD). Macroscopically, impacted thick mucus protruded into the CBD from the pancreas via a pancreatobiliary fistula. Histologic examination revealed a pancreatobiliary fistula caused by intraductal papillary-mucinous carcinoma of the pancreas with mucin hypersecretion, an adenoma without interstitial infiltration, and isolated implantation of an IPMN in the bile duct mucosa around the fistula.
authors: Department of Surgery, Mito Red Cross Hospital, Sannomaru, Mito, Ibaraki 310-0011, Japan.
authors: Ken-ichi
authors: K
authors: Okada
authors: Takayuki
authors: T
authors: Furuuchi
authors: Tomoyuki
authors: T
authors: Tamada
authors: Takahiro
authors: T
authors: Sasaki
authors: Tatsushi
authors: T
authors: Suwa
authors: Tomoo
authors: T
authors: Shatari
authors: Yoshifumi
authors: Y
authors: Takenaka
authors: Masao
authors: M
authors: Hori
authors: Masayoshi
authors: M
authors: Sakuma
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D001658:Biliary Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002291:Carcinoma, Papillary / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D010185:Pancreatic Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*