Case Report
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World J Gastrointest Endosc. Dec 16, 2014; 6(12): 620-624
Published online Dec 16, 2014. doi: 10.4253/wjge.v6.i12.620
Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct
Stefano Francesco Crinò, Giuseppe Scalisi, Pierluigi Consolo, Doriana Varvara, Antonio Bottari, Sebastiano Pantè, Socrate Pallio
Stefano Francesco Crinò, Giuseppe Scalisi, Pierluigi Consolo, Doriana Varvara, Socrate Pallio, Digestive Endoscopy Unit, University Hospital, 98100 Messina, Italy
Antonio Bottari, Radiological Sciences, University Hospital, 98100 Messina, Italy
Sebastiano Pantè, General Surgery Unit, University Hospital, 98100 Messina, Italy
Author contributions: Crinò SF, Scalisi G and Varvara D had contributed to the conception and design of the article and had also collected and analyzed data; Consolo P and Pallio S had performed the two ERCP; Crinò SF had performed the EUS and the consequent drainage; Bottari A had performed the CT scan; Pantè S, Scalisi G and Varvara D had clinically managed the patient; Crinò SF and Scalisi G had drafted the article and revised it critically for important intellectual content; all the authors had approved the final version to be published.
Correspondence to: Giuseppe Scalisi, MD, Digestive Endoscopy Unit, University Hospital, via consolare Valeria 1, 98100 Messina, Italy. scalisi.giuseppe@alice.it
Telephone: +39-90-2212294 Fax: +39-90-2212312
Received: July 22, 2014
Revised: September 22, 2014
Accepted: October 14, 2014
Published online: December 16, 2014
Processing time: 149 Days and 0.5 Hours
Abstract

Pancreatic pseudocyst formation is a well-known complication of pancreatitis. It represents about 75% of the cystic lesions of the pancreas and might be located within or surrounding the pancreatic tissue. Sixty percent of the occurrences resolve spontaneously and only persistent, symptomatic or complicated cysts need to be treated. Complications include infection, hemorrhage, gastric outlet obstruction, splenic infarction and rupture. The formation of fistulas to other viscera is rare and most commonly occurs within the stomach, duodenum or colon. We report a case of a patient with a pancreatic pseudocyst in communication with the common bile duct. There have been only few cases reported in the literature. We successfully managed our case by performing an endoscopic ultrasound-guided drainage of the pancreatic collection and a contemporaneous stenting of the common bile duct. Performed independently, both drainages are effective, safe and well-coded and the expertise on these procedures is widespread. By our knowledge this therapeutic approach was never reported in literature but we retain this is the most correct treatment for this very rare condition.

Keywords: Pancreatic pseudocyst, Fistula, Common bile duct, Endoscopic retrograde cholangiopancreatography, Endoscopic ultrasound

Core tip: In our opinion the combination of endoscopic ultrasound-guided drainage of the pseudocyst and the simultaneous biliary stenting represent the best endoscopic treatment. The advantages of such approach consist in a better evaluation and a more effective drainage of the cystic cavity with the possibility to collect samples for biochemical and bacteriological analysis. Furthermore, the simultaneous biliary stenting can determine, at the same time, a pressure reduction in the bile system and in the pancreatic collection facilitating the healing of the fistula.