A CASE OF CHRONIC PANCREATITIS WITH A PANCREATICOBILIARY FISTULA RESOLVED BY ENDOSCOPIC STENTING

Abstract

A 47-year-old male with a history of alcoholic chronic pancreatitis presented with epigastralgia over a period of several days. Laboratory data showed elevated hepatobiliary enzymes and amylase. CT images revealed a pancreatic pseudocyst with an intracystic aneurysm. Imaging also demonstrated stenosis of the inferior bile duct and proximal dilation. We performed transcatheter arterial embolization for the aneurysm and percutaneous transhepatic biliary drainage for the obstructive jaundice. Subsequent ERCP showed stenosis of the biliary duct and the main pancreatic duct in the pancreatic head in addition to a pancreaticobiliary fistula. We performed stenting of the biliary and pancreatic ducts and exchanged stents repeatedly at 1- to 2-month intervals. Thirteen months after the fistula appeared, we removed both stents after confirmation that the stenosis of both ducts was resolved and that the fistula had disappeared. Half a year after the removal of both stents, the patient remains in good condition without clinical recurrence.