• Acute pancreatitis
• Chronic pancreatitis
• Pancreatic portal vein fistula
• Pancreatitis complication
• Panniculitis

• Humans
• Portal Vein/diagnostic imaging
• Portal Vein/pathology
• Pancreatic Fistula/etiology
• Pancreatic Fistula/epidemiology
• Male
• Middle Aged
• Female
• Vascular Fistula/complications
• Vascular Fistula/diagnostic imaging

• chronic pancreatitis
• pancreatic pseudocyst
• pancreatic pseudocyst-portal venous fistula

• Acute pancreatitis
• Consenso
• Consensus
• Pancreatitis aguda
• Pancreatitis aguda recurrente
• Pediatrics
• Pediatría
• Recurrent acute pancreatitis

• Adult
• Humans
• Child
• Adolescent
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Consensus
• Acute Disease
• Mexico/epidemiology

Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.

The aims of this study were to: Propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up. We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications, with the exclusion of pancreatic insufficiency. The primary outcomes were prevalence of complications of CP at baseline (prior to surgical treatment) and occurrence of new complications during follow-up.

After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of CP complications evaluated, according to the proposed classification, in a surgical cohort of 166 patients. Development of the pathophysiological classification was based on a literature review on the clinical presentation, course, and complications of CP, as well a review of previous classification systems of CP.

We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3%, and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, at 15 years following surgery. Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications, but was associated with the highest rate of pancreatic exocrine insufficiency.

The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.

• Chronic pancreatitis
• Complications
• Classification
• Pathophysiology
• Surgical treatment

Intraperitoneal air in pancreatic pseudocysts is a rare complication that can jeopardize hemodynamic stability and requires emergency surgery. A 61-year-old man was admitted to our hospital after abdominal pain, vomiting and diarrhea. Computed tomography showed a hollow visceral perforation with intraperitoneal air and two pseudocysts close to the pancreas. The patient was transferred to the emergency operating room with symptoms of septic shock. We histopathologically diagnosed a ruptured pancreatic pseudocyst combined with an intracystic haemorrhage. We resected a portion of the pseudocyst wall using surface electrocautery inside the lumen, cholecystectomy and peritoneal toilet and maintained adequate external drainage. The patient was discharged on postoperative Day 12. The patient achieved relapse-free survival for 12 months postoperatively. Ruptured pancreatic pseudocysts with extraluminal gas are dangerous if effective medical interventions are not performed. Emergency surgery should be completed as soon as possible to drain the pancreatic cyst and cleanse the abdomen.

• Chronic pancreatitis
• Hemosuccus pancreaticus
• Pancreatic-portal vein fistula
• Recurrent acute pancreatitis

• Acute Disease
• Female
• Humans
• Male
• Middle Aged
• Pancreas
• Pancreatic Fistula/etiology
• Pancreatitis
• Portal Vein/diagnostic imaging
• Retrospective Studies

Pancreatic fluid collections (PFC) are notorious for their extension beyond the normal confines of the pancreatic bed. This distribution is explained by dissection along the fascial planes in retroperitoneum due to the digestive enzymes within the PFC. In genitourinary track, PFCs have been described to involve the kidneys and the ureters. We report a case of severe acute necrotizing pancreatitis in a 28-year-old male, chronic alcoholic, who on readmission developed features of cystitis. The urine was turbid but did not show significant bacteriuria. Close location of the PFC near the urinary bladder (UB) prompted evaluation of urinary lipase and amylase. Elevated urinary enzyme levels suggested a Pancreatico-vesical fistula, conclusive demonstration of which was established by CT cystography. Percutaneous drainage of the necrosum and stenting of pancreatic duct led to spontaneous healing of the pancreatico-vesical fistula. Our case reiterates the remarkable property of pancreatic enzymes to dissect the fascial planes which is demonstrated by decompression of PFC via UB causing spontaneous Pancreatico-vesical fistula. Further, presence of main pancreatic duct fistulization should prompt endoscopic-guided stenting to obliterate the communication with the fistula and accelerate healing.

• Acute necrotizing pancreatitis
• pancreatic fistula
• urinary bladder fistula

Pseudocyst formation is common in chronic pancreatitis. A rare subset of these patients may develop fistulization between the pseudocyst and the portal vein system. We report a case of spontaneous pancreatic pseudocyst – superior mesenteric vein fistula in a 61-year-old male with a history of chronic recurrent calcifying pancreatitis. The fistulous connection was correctly identified on both computed tomography and magnetic resonance cholangiopancreatography (MRCP), and the patient was treated successfully with a conservative approach. Our case report aims to educate on this rare and potentially fatal vascular complication of chronic pancreatitis and to discuss the role of modern noninvasive imaging techniques, such as T2-weighted MRI/MRCP, in establishing this diagnosis and making a decision regarding its management.

• Magnetic resonance cholangiopancreatography
• Pancreatic-portal vein fistula
• Pancreatitis
• Pseudocyst
• Superior mesenteric vein

Pancreatic pseudocyst-portal vein (PP-PV) fistula, mostly occurring after pseudocyst formation following acute/chronic pancreatitis, is a rare but life-threatening condition. The majority of treatments are based on conservative or surgical interventions. We report the case of a 70-year-old man with a PP-PV fistula and PV thrombosis. We adopted conservative treatment at first due to his mild symptoms. However, after resuming food intake, the patient had severe abdominal pain. Following endoscopic retrograde cholangiopancreatography, we found that the pseudocyst was connected with the PV through the fistula. Subsequently, an endoscopic nasopancreatic drainage (ENPD) catheter was inserted into the main pancreatic duct to establish pancreatic drainage, which resulted in a decrease in the abdominal pain. After the ENPD tube had been exchanged for endoscopic pancreatic stenting, his abdominal pain did not recur. Therefore, this case demonstrated endoscopic treatment as an effective treatment option for PP-PV fistula.

• Endoscopic pancreatic stenting
• Pancreatic pseudocyst-portal vein fistula
• Pancreatitis

• Anti-Bacterial Agents/therapeutic use
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangiopancreatography, Magnetic Resonance
• Common Bile Duct/diagnostic imaging
• Drainage
• Female
• Humans
• Imaging, Three-Dimensional
• Jaundice, Obstructive/etiology
• Jaundice, Obstructive/therapy
• Middle Aged
• Pancreatic Fistula/diagnostic imaging
• Pancreatic Fistula/etiology
• Pancreatic Fistula/therapy
• Pancreatic Pseudocyst/diagnostic imaging
• Pancreatic Pseudocyst/etiology
• Pancreatic Pseudocyst/therapy
• Pancreatitis
• Portal Vein/diagnostic imaging
• Stents
• Tomography, X-Ray Computed
• Ultrasonography, Doppler, Color

• EUS-CD
• Endoscopic ultrasound-guided cyst-drainage
• Portal vein thrombosis
• Pseudocyst-portal vein fistula

• Aged
• Drainage
• Endosonography
• Female
• Humans
• Pancreatic Fistula/diagnostic imaging
• Pancreatic Fistula/etiology
• Pancreatic Fistula/therapy
• Pancreatic Pseudocyst/complications
• Pancreatic Pseudocyst/diagnostic imaging
• Pancreatic Pseudocyst/surgery
• Portal Vein/diagnostic imaging

• hereditary pancreatitis
• pediatric chronic pancreatitis
• pseudocyst-portal vein fistula
• total pancreatectomy and islet autotransplant
• vein reconstruction

A pancreatic-portal vein fistula (PPVF) is an extremely rare complication of pancreatitis. In this report, we present a patient with a PPVF in the setting of recurrent pancreatitis and portal vein thrombosis diagnosed by cross-sectional imaging and endoscopic retrograde cholangio-pancreatography, who responded to medical management and anticoagulation. A critical review of this disease process is explored to highlight pathology, imaging characteristics, and essential alternative diagnostic considerations. We also discuss potential complications and current treatment strategies. PPVFs pose a unique diagnostic challenge and awareness of its clinical presentation can further improve patient outcomes.

• Complications
• pancreaticoportal fistula
• pancreatitis
• portal vein
• pseudocyst

• CT
• Fistula
• MR
• Pancreatic pseudocyst
• Pancreatitis
• Portal vein

• Cyst gastrostomy
• Fistula
• Hemorrhage
• Pancreatic pseudocyst
• Pancreatitis
• Portal vein thrombosis