Itagaki Yuki, Sato Shoki, Omori Yuko, Yamamoto Hiroyuki, Kimura Kotaro, Kushiya Hiroki, Tsunetoshi Yusuke, Kato Kentaro, Takada Minoru, Ambo Yoshiyasu, Ota Satoshi, Hirano Satoshi
Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Medicine (Baltimore). 2025 Aug 1;104(31):e43563. doi: 10.1097/MD.0000000000043563.
Intraductal papillary mucinous neoplasms (IPMNs) may perforate into adjacent organs, but pancreaticobiliary fistula caused by IPMN is rare. We present a rare case of pancreaticobiliary fistula due to a branch-duct IPMN, accelerated by a simultaneous ampullary carcinoma.
A woman in her 70s developed obstructive jaundice and cholangitis after a year of follow-up for IPMN.
Imaging revealed a branch-duct IPMN with a mural nodule and dilation of the main pancreatic duct, along with a dilated distal bile duct. Perforation into the bile duct and lymphadenopathy were observed. Histopathology later confirmed a high-grade intestinal-type IPMN and an incidental ampullary ductal carcinoma.
The patient underwent endoscopic biliary drainage followed by pancreaticoduodenectomy after improvement of cholangitis.
The postoperative course was favorable. The pancreaticobiliary fistula was attributed to mechanical compression by mucin-producing IPMN, complicated by ampullary carcinoma.
This case highlights the importance of recognizing synergistic effects of concurrent periampullary neoplasms. Surgical resection may be curative and necessary to control complex biliary obstruction and infection.
导管内乳头状黏液性肿瘤（IPMNs）可能会穿破至邻近器官，但由IPMN引起的胰胆管瘘很少见。我们报告一例罕见的因分支导管IPMN导致的胰胆管瘘，同时合并壶腹癌加速了病情发展。
一名70多岁的女性在对IPMN进行一年随访后出现梗阻性黄疸和胆管炎。
影像学检查显示一个带有壁结节的分支导管IPMN，主胰管扩张，同时远端胆管也扩张。观察到有穿破至胆管及淋巴结病变。组织病理学后来证实为高级别肠型IPMN及偶然发现的壶腹导管癌。
患者先接受了内镜下胆管引流，在胆管炎改善后进行了胰十二指肠切除术。
术后病程顺利。胰胆管瘘归因于产生黏液的IPMN的机械压迫，并合并壶腹癌。
该病例突出了认识壶腹周围同时存在的肿瘤协同效应的重要性。手术切除对于控制复杂的胆管梗阻和感染可能是治愈性的且必要的。
