Use of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Fistula
1976; Elsevier BV; Volume: 70; Issue: 4 Linguagem: Inglês
10.1016/s0016-5085(76)80500-8
ISSN1528-0012
AutoresTheodore W. Bohlman, Ronald M. Katon, Timothy G. Lee, Larry R. Eidemiller,
Tópico(s)Biliary and Gastrointestinal Fistulas
ResumoThe diagnosis in a case of pancreaticocolonic fistula, presenting with gastrointestinal bleeding, was made by endoscopic retrograde cholangiopancreatography (ERCP) and verified surgically.The clinical picture and pathogenesis of pancreaticoenteric fistulas are reviewed.Pancreatic pseudocyst is a well recognized complication of pancreatitis, occurring in approximately 2% of cases. 1 Fistulization occurring from such a cyst is rare, with less than 40 cases reported in the English literature.These fistulous communications most commonly connect with stomach, duodenum, or colon,2 although other sites are reported.This report concerns a case of pancreaticocolonic fistula which presented with major lower gastrointestinal bleeding.The diagnosis was established by endoscopic retrograde cholangiopancreatography (ERCP). Case ReportT. D. is a 43-year-old male American Indian.In November 1972 he was admitted to the hospital for evaluation of nausea, vomiting, and epigastric pain.Physical examination at that time was unremarkable.Admitting white blood count, serum electrolytes, serum calcium, and abdominal X-ray were normal.Serum, 2-hr urinary amylase, and subsequent upper G.!. series and barium enema were normal.A provisional diagnosis of gastritis was made.The patient's pain and vomiting gradually improved on a medical regimen.He was discharged feeling well, and was lost to follow-up.He was readmitted to the University Hospital South on July 31, 1974, complaining of melena, hematochezia, and orthostatic dizziness for 2 days.There was no history of peptic ulcer disease or previous GJ.bleeding and he denied abdominal pain, hematemesis, nausea, vomiting, early satiety, change in bowel habits, or diarrhea.The patient reported a recent 30-pound weight loss despite a vigorous appetite.He had a 20-year history of liberal alcohol ingestion, and was currently under treatment for pulmonary tuberculosis.Alcohol intake continued to be heavy before admission, but he denied ingestion of salicylates.
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