A Case of Pancreatico-gastric Fistulaafter Chronic Relapsing Pancreatitis

Lee, Soong; Jang, An Soo; Yang, Seung Won; Seo, Jeong Pyeong; Joh, Nam Joong; Park, Hong Bae

Abstract

Pancreatic fistula is a rare complication which occurs in acute and chronic pancreatitis, or after trau matic or surgical disruption of pancreatic duct. Fistula may drain spontaneously into adjacent hollow viscera, peritoneal and pleural cavities (internal fistula) or communicate with the body surface exter nally (external fistula). We recently experienced a case of pancreatico-gastric fistula after acute phase of chronic pancreatitis without pseudocyst. To our knowledge, this is the first case in Korea. The patient was a 75-year-old man with epigastric and left upper quadrant abdominal pain. Abdomina computerized tomography (CT) and ultrasonography showed enlarged, poorly marginated pancreas with irregular dilated pancreatic duct. Endoscopic examination showed small orifice with marginal whitish mucosa at posterior wall side of gastric antrum. Endoscopic retrograde cholangiopancreato graphy showed irregular dilated duct in tail of pancreas and collection of contrast medium in fundu of stomach. CT guided aspiration and biopsy of pancreas showed fibroadipose tissue infiltrated with chronic inflammatory cells.