Gonçalves André, Leal Carina, Cotrim Isabel, Vasconcelos Helena
Gastrenterology, Centro Hospitalar de Leiria, Portugal.
Gastroenterology, Centro Hospitalar de Leiria, Portugal.
Rev Esp Enferm Dig. 2024 Jan 11. doi: 10.17235/reed.2024.10125/2023.
Pancreatobiliary fistulas associated withntraductal Papillary Mucinous Neoplasm (IPMN) are rare and present therapeutic challenges. The authors describe the clinical course of an 81-year-old woman presenting with acute cholangitis, ultimately diagnosed with IPMN involving secondary ducts with focal high-grade dysplasia. Initial manifestations included elevated inflammatory markers, cholestasis, and imaging findings of a pancreatic lesion. Endoscopic retrograde cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts, along a cystic cluster originating from the pancreas, fistulizing into the common bile duct. Despite initial endoscopic interventions, recurrent cholestasis persisted. Subsequent multidisciplinary evaluation led to a cephalic duodenopancreatectomy. This case underscores the rarity of pancreatobiliary fistulas associated with IPMNs and the subsequent therapeutic challenges. The absence of standardized treatment algorithms for such intricate cases emphasizes the importance of individualized approaches. The fluoroscopy image displaying a cystic cluster originating from the pancreas and showing fistulization into the common bile duct is a rare image presented in our report, unique to this case.
与导管内乳头状黏液性肿瘤（IPMN）相关的胰胆瘘罕见，且带来治疗挑战。作者描述了一名81岁女性的临床病程，该患者以急性胆管炎就诊，最终诊断为IPMN累及二级导管并伴有局灶性高级别异型增生。初始表现包括炎症标志物升高、胆汁淤积以及胰腺病变的影像学表现。内镜逆行胰胆管造影显示肝内和肝外胆管均扩张，沿源自胰腺的一个囊肿群，瘘入胆总管。尽管进行了初始内镜干预，胆汁淤积仍反复出现。随后的多学科评估导致行了胰头十二指肠切除术。该病例强调了与IPMN相关的胰胆瘘的罕见性以及随后的治疗挑战。对于此类复杂病例缺乏标准化治疗算法凸显了个体化方法的重要性。本报告中呈现的显示源自胰腺的囊肿群并显示瘘入胆总管的荧光透视图像是一张罕见图像，为此病例所特有。
