Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):155-159. 10.14701/ahbps.2021.25.1.155.

Pancreatic pseudocyst with fistula to the dilated common bile duct: Mimmicking choledocal cyst?

• Gustavo N
• Alesio L
• Lorna RT
• Eugenia DE
• Flavia L

• KMID: 2513191
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.155

Abstract

We present a rare case of a fistula between a pancreatic pseudocyst and the bile duct with saccular dilatation that appeared to be a type I choledocal cyst. There are only 19 described cases in the consulted bibliography. The patient was studied with an ultrasound, CT and MRCP and later surgically intervened. A resection was performed of the extrahepatic biliary and hepaticojejunostomy. There was a subsequent good evolution

Keyword

Pancreatic; Pseudocyst; Fistula; Bile duct

Figure

• 

  Fig. 1 CT showing the pseudocyst and the great dilatation of the bile ducts.

• 

  Fig. 2 MRCP, pseudocyst is comunicated and compressing the bile duct.

• 

  Fig. 3 Intraoperative Cholangiography. Bile duct dilatation comunicated with pseudocyst.

Reference

1. León FF, Tapia VÁ, Avendaño RG. 2013; [Fistula formation between a pancreatic pseudocyst and the biliary tree]. Rev Chil Cir. 65:549–553. Spanish. DOI: 10.4067/S0718-40262013000600014.

2. Al Ali JA, Chung H, Munk PL, Byrne MF. 2009; Pancreatic pseudocyst with fistula to the common bile duct resolved by combined biliary and pancreatic stenting--a case report and literature review. Can J Gastroenterol. 23:557–559. DOI: 10.1155/2009/597208. PMID: 19668801. PMCID: PMC2732178.

3. DeVanna T, Dunne MG, Haney PJ. 1983; Fistulous communication of pseudocyst to the common bile duct: a complication of pancreatitis. Pediatr Radiol. 13:344–345. DOI: 10.1007/BF01625964. PMID: 6646890.

4. Raimondo M, Ashby AM, York EA, Derfus GA, Farnell MB, Clain JE. 1998; Pancreatic pseudocyst with fistula to the common bile duct presenting with gastrointestinal bleeding. Dig Dis Sci. 43:2622–2626. DOI: 10.1023/A:1026638908243. PMID: 9881492.

5. Hauptmann EM, Wojtowycz M, Reichelderfer M, McDermott JC, Crummy AB. 1992; Pancreatic pseudocyst with fistula to the common bile duct: radiological diagnosis and management. Gastrointest Radiol. 17:151–153. DOI: 10.1007/BF01888533. PMID: 1551513.

6. Carrere C, Heyries L, Barthet M, Bernard JP, Grimaud JC, Sahel J. 2001; Biliopancreatic fistulas complicating pancreatic pseudocysts: a report of three cases demonstrated by endoscopic retrograde cholangiopancreatography. Endoscopy. 33:91–94. DOI: 10.1055/s-2001-11177. PMID: 11204997.

7. Skellenger ME, Patterson D, Foley NT, Jordan PH Jr. 1983; Cholestasis due to compression of the common bile duct by pancreatic pseudocysts. Am J Surg. 145:343–348. DOI: 10.1016/0002-9610(83)90197-6. PMID: 6837858.

8. Dalton WE, Lee HM, Williams GM, Hume DM. 1970; Pancreatic pseudocyst causing hemobilia and massive gastrointestinal hemorrhage. Am J Surg. 120:106–107. DOI: 10.1016/S0002-9610(70)80158-1. PMID: 5310578.

9. Grace RR, Jordan PH Jr. 1976; Unresolved problems of pancreatic pseudocysts. Ann Surg. 184:16–21. DOI: 10.1097/00000658-197607000-00002. PMID: 938112. PMCID: PMC1344298.

10. Sankaran S, Walt AJ. 1975; The natural and unnatural history of pancreatic pseudocysts. Br J Surg. 62:37–44. DOI: 10.1002/bjs.1800620110. PMID: 1111673.

11. Gadacz TR, Lillemoe K, Zinner M, Merrill W. 1983; Common bile duct complications of pancreatitis evaluation and treatment. Surgery. 93:235–242.

12. Ellenbogen KA, Cameron JL, Cocco AE, Gayler BW, Hutcheon DF. 1981; Fistulous communication of a pseudocyst with the common bile duct: demonstration by endoscopic retrograde cholangiopancreatography. Johns Hopkins Med J. 149:110–111. PMID: 7289343.

13. Bresler L, Vidrequin A, Poussot D, Mangin P, Pinelli G, Boissel P, et al. 1989; Fistulous communication of a pancreatic pseudocyst with the common bile duct: demonstration by operative cholangiogram. Am J Gastroenterol. 84:835–836. PMID: 2741897.

14. Boulanger S, Volpe CM, Ullah A, Lindfield V, Doerr R. 2001; Pancreatic pseudocyst with biliary fistula: treatment with endoscopic internal drainage. South Med J. 94:347–349. DOI: 10.1097/00007611-200194030-00016. PMID: 11284527.

15. Ragunath K, Anagnostopoulos GK, Dunn K. 2006; Education and imaging. Hepatobiliary and pancreatic: choledochopancreatic fistula complicating acute pancreatitis. J Gastroenterol Hepatol. 21:1753. DOI: 10.1111/j.1440-1746.2006.04745.x. PMID: 16984602.

16. Rickes S, Mönkemüller K, Peitz U, Schinkel S, Kolfenbach S, Malfertheiner P, et al. 2006; Sonographic diagnosis and endoscopic therapy of a biliopancreatic fistula complicating a pancreatic pseudocyst. Scand J Gastroenterol. 41:989–992. DOI: 10.1080/00365520600581553. PMID: 16803699.

17. Nari GA, Nassar M, Moreno E, Ponce O. 2001; Congenital cystic dilation of the biliary tract. Report on six patients. Cir Gen. 23:168–172.

18. Nari G, Granero L, Silva J, Layún J, Mariot D, Duran N, et al. 2019; [Pancreatic fistula after pancreaticoduodenectomy. Pancreaticogastrostomy vs. pancreaticojejunostomy]. Rev Argent Cirug. 111:79–89. Spanish.