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

Autor: Kenneth K.W. Lee, Dhiraj Yadav, Paula M. Novelli, Mark D'Alesio, Hao Liu, Alessandro Paniccia, Amer H. Zureikat, Steven Lebowitz, Anil K. Dasyam, Biatta Sholosh, Stephanie Romutis, Anna E. Phillips, Harkirat Singh
Rok vydání: 2021
Předmět:
Zdroj: Journal of Gastrointestinal Surgery. 25:3137-3148
ISSN: 1873-4626
1091-255X
Popis: To determine factors affecting mortality, and long-term patency of portal vein, in patients with pancreatic-portal vein fistula (PPVF). 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. 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. 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.
Databáze: OpenAIRE
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