title: Pancreaticoportal fistula and disseminated fat necrosis after revision of a transjugular intrahepatic portosystemic shunt.
abstract: A 59-year old man with alcohol related cirrhosis and portal hypertension was referred for transjugular intrahepatic portosystemic shunt (TIPS) to treat his refractory ascites. Ten years later, two sequential TIPS revisions were performed for shunt stenosis and recurrent ascites. After these revisions, he returned with increased serum pancreatic enzyme levels and disseminated superficial fat necrosis; an iatrogenic pancreaticoportal vein fistula caused by disruption of the pancreatic duct was suspected. The bare area of the TIPS was subsequently lined with a covered stent-graft, and serum enzyme levels returned to baseline. In the interval follow-up period, the patient has clinically improved.
authors.affiliation: Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, St. Louis, MO 63110, USA. kleins@mir.wustl.edu
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Klein
authors.forename: Nael
authors.initials: N
authors.lastname: Saad
authors.forename: Kevin
authors.initials: K
authors.lastname: Korenblat
authors.forename: Michael D
authors.initials: MD
authors.lastname: Darcy
mesh_terms: D015901:Angiography, Digital Subtraction; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D005218:Fat Necrosis / Q000209:etiology* / Q000601:surgery*; D005402:Fistula / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007049:Iatrogenic Disease; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012086:Reoperation; D015607:Stents