title: Massive pancreatic pseudocyst with portal vein fistula: case report and proposed treatment algorithm.
abstract: Pancreatic pseudocyst is a relatively common occurrence resulting from acute or chronic pancreatitis. However, a rare subset of these patients present with a pseudocyst fistulizing into the portal vein. We present the case of a 58 year-old woman with a rapidly expanding pancreatic pseudocyst with portal venous fistulization causing portal vein thrombosis, in addition to biliary and duodenal obstruction. The patient underwent surgical decompression with a cyst-gastrostomy and was well until one week post-operatively when she experienced massive gastrointestinal hemorrhage leading to her death. A review of the literature is presented and a treatment algorithm to manage patients with pancreatic pseudocyst to portal vein fistula is proposed.
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Thomas S C
authors.initials: TS
authors.lastname: Ng
authors.affiliation: Division of Hepatobiliary, Pancreatic and Abdominal Organ Transplant Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Rochefort
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Czaplicki
authors.affiliation: Division of Hepatobiliary, Pancreatic and Abdominal Organ Transplant Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Teixeira
authors.affiliation: Visualization & Interface Design Innovation (VIDI) Research Group, University of California, Davis, Davis, CA, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Division of Hepatobiliary, Pancreatic and Abdominal Organ Transplant Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Lea
authors.initials: L
authors.lastname: Matsuoka
authors.affiliation: Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Jacques
authors.initials: J
authors.lastname: Van Dam
authors.affiliation: Division of Hepatobiliary, Pancreatic and Abdominal Organ Transplant Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: Sophoclis.Alexopoulos@med.usc.edu.
authors.forename: Sophoclis P
authors.initials: SP
authors.lastname: Alexopoulos
mesh_terms: D000465:Algorithms; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology* / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000150:complications* / Q000601:surgery; D011169:Portal Vein; D016157:Vascular Fistula / Q000209:etiology* / Q000601:surgery
keywords: Cyst gastrostomy; Fistula; Hemorrhage; Pancreatic pseudocyst; Pancreatitis; Portal vein thrombosis