A Case of Cystoduodenal and Cystocolic Fistula Complicated in Pancreatic Pseudocyst

Choi, Woo Bong; Jang, Jae Young; Ham, Jeong Sik; Cho, Young Deok; Kim, Jin Oh; Cho, Joo Young; Lee, Joon Seong; Lee, Moon Sung; Shim, Chan Sup

Abstract

Spontaneous rupture of pancreatic pseudocyst occurs in less than 5 % of the cases. Rupture has been reported to occur in free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and abdominal wall. The precise pathophysiologic mechanism of rupture is unknown. However, the increased intracystic pressure has been suggested as a factor leading to rupture. The wall gives way at the weakest point of it when the pressure reaches a critical level, or increased intracystic pressure may compromise the wall vasculature with subsequent necrosis and rupture. Enzymatic activity on the wall might also produce vascular damage with subsequent necrosis of the wall and subsequent rupture. The reported case of spontaneous rupture into more than one hollow viscus is very rare in our country. We report a case of cystoduodenal and cystocolic fistula complicated after endoscopic internal drainage of pancreatic pseudocyst in acute pancreatitis. The patient has been treated completely by endoscopic nasogastric drainage.