Pancreaticoureteral Fistula: A Rare Complication of Chronic Pancreatitis.
BACKGROUND
Chronic pancreatitis is an inflammatory condition that may result in progressive parenchymal damage and fibrosis which can ultimately lead to destruction of pancreatic tissue. Fistulas to the pleura, peritoneum, pericardium, and peripancreatic organs may form as a complications of pancreatitis. This case report describes an exceedingly rare complication, pancreaticoureteral fistula (PUF). Only two additional cases of PUF have been reported. However, they evolved following traumatic injury to the ureter or pancreatic duct. No published reports describe PUF as a complication of pancreatitis.


METHODS
A 69-year-old Hispanic female with a past medical history of cholecystectomy, pancreatic pseudocyst, and recurrent episodes of pancreatitis presented with severe, sharp, and constant abdominal pain. Upon imaging, a fistulous tract was visualized between the left renal pelvis (at the level of an upper pole calyx) and the pancreatic duct and a ureteral stent was placed to facilitate fistula closure. Following the procedure, the patient attained symptomatic relief and oral intake was resumed. A left retrograde pyelogram was repeated 2 months after the initial stent placement and demonstrating no evidence of a persistent fistulous tract.


CONCLUSIONS
Due to PUF's unclear etiology and possible variance of presentation, it is important for physicians to keep this rare complication of pancreatitis in mind, especially, when evaluating a patient with recurrent pancreatitis, urinary symptoms and abnormal imaging within the urinary collecting system and pancreas.
Department of Medicine, Division of Gastroenterology, St. Joseph's Regional Medical Center, Paterson, New Jersey, USA.
Hiren G
HG
Patel
Department of Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA; Department of Medicine, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey, USA.
Yana
Y
Cavanagh
Department of Medicine, Division of Gastroenterology, St. Joseph's Regional Medical Center, Paterson, New Jersey, USA.
Sohail N
SN
Shaikh
Chronic pancreatitis; complication; fistula; fistulous tract; pancreas; pancreaticoureteral; pancreaticoureteral fistula (PUF); pancreatitis; ureter