Pancreatic pseudocyst and pancreatico-duodenal fistula diagnosed by endoscopic fistulography.

To our knowledge, primary endoscopic diagnosis of pancreaticoduodenal fistulae has not so far been reported. The diagnosis is often made radiographically at endoscopic retrograde cholangiopancreatography (ERCP). We report one such case, in which a barium meal x-ray suggested duodenal ulceration, and the endoscopic findings suggested a duodenal diverticulum, the bottom of which could not be clearly defined. Instillation of contrast medium revealed the true fistulous nature of the diverticulum-like defect in the duodenal wall. This patient also had a pancreatic pseudocyst communicating with the fistula through the caudal part of the pancreatic duct, visualized during endoscopic fistulography. The patient did well on conservative treatment without surgical intervention.