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Liu H, Phillips A, Sholosh B, et al. Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications-13-Year Experience of a Pancreas Center of Excellence. J Gastrointest Surg. 2021;25(12):3137-3148doi: 10.1007/s11605-021-05071-5.
Liu, H., Phillips, A., Sholosh, B., Novelli, P., Romutis, S., D'Alesio, M., Lebowitz, S., Singh, H., Yadav, D., Zureikat, A., Lee, K., Paniccia, A., & Dasyam, A. K. (2021). Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications-13-Year Experience of a Pancreas Center of Excellence. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 25(12), 3137-3148. https://doi.org/10.1007/s11605-021-05071-5
Liu, Hao, et al. "Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications-13-Year Experience of a Pancreas Center of Excellence." Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract vol. 25,12 (2021): 3137-3148. doi: https://doi.org/10.1007/s11605-021-05071-5
Liu H, Phillips A, Sholosh B, Novelli P, Romutis S, D'Alesio M, Lebowitz S, Singh H, Yadav D, Zureikat A, Lee K, Paniccia A, Dasyam AK. Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications-13-Year Experience of a Pancreas Center of Excellence. J Gastrointest Surg. 2021 Dec;25(12):3137-3148. doi: 10.1007/s11605-021-05071-5. Epub 2021 Jul 12. PMID: 34254216.
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J Gastrointest Surg. 2021 Dec;25(12):3137-3148. doi: 10.1007/s11605-021-05071-5. Epub 2021 Jul 12.

Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications-13-Year Experience of a Pancreas Center of Excellence.

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

Hao Liu, Anna Phillips, Biatta Sholosh, Paula Novelli, Stephanie Romutis, Mark D'Alesio, Steven Lebowitz, Harkirat Singh, Dhiraj Yadav, Amer Zureikat, Kenneth Lee, Alessandro Paniccia, Anil K Dasyam

Affiliations

  1. Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
  2. Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
  3. Abdominal Imaging Division, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
  4. Interventional Radiology Division, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
  5. School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
  6. Abdominal Imaging Division, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA. [email protected].

PMID: 34254216 DOI: 10.1007/s11605-021-05071-5

Abstract

PURPOSE: To determine factors affecting mortality, and long-term patency of portal vein, in patients with pancreatic-portal vein fistula (PPVF).

METHODS: Consecutive cases of PPVF at the University of Pittsburgh Medical Center from 2008 to 2020 were retrospectively identified. Clinical history, imaging studies, management strategies, complications, and long-term outcomes were analyzed.

RESULTS: Fourteen patients, representing the largest PPVF cohort reported to date (mean age 58.6 years, 64.3% women, median follow-up 10 months [1-98 months]) were identified. Underlying chronic pancreatitis was seen in 9 (64.3%) patients, while 5 (35.7%) developed PPVF with first attack of acute pancreatitis. PPVF involved proximal main portal vein (MPV) in 10 (78.6%) patients. Of the 5 patients (35.7%) who died, all had occlusive (n=4) or near-occlusive (n=1) PPVF-associated filling defect (FD) in the MPV. Conversely, 7 of 9 survivors (87.5%) had subocclusive FD and patent MPV. In patients with sepsis (n=5), 1 underwent surgical necrosectomy and survived, while 3 of 4 (75%) patients without debridement died.

CONCLUSION: Occlusive/near-occlusive PPVF-associated MPV FD, and sepsis, are associated with high mortality rates, while subocclusive MPV FD is associated with survival and long-term MPV patency. PPVF is a potentially life-threatening, and possibly under-diagnosed, entity that warrants early clinical suspicion for timely diagnosis, to facilitate optimal management.

© 2021. The Society for Surgery of the Alimentary Tract.

Keywords: Chronic pancreatitis; Hemosuccus pancreaticus; Pancreatic-portal vein fistula; Recurrent acute pancreatitis

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