Abstract
We report a case of pancreatic fistula with portal vein thrombosis which grew rapidly and an infected pancreatic pseudocyst caused by the pancreatic fistula penetrated into the portal vein after laparoscopic distal pancreatectomy. A 68-year-old woman underwent laparoscopic distal pancreatectomy for a branch duct type intraductal papillary mucinous neoplasm (IPMN) 34 mm in diameter at the pancreatic body. We removed the drain on the 4th day after the operation. Because the amount of the discharge was as small as 15 ml/day and no signs of infection were seen on the 3rd day, though the amylase value in the drain was high, 213,000 IU/l. On the 9th day, however, a pancreatic pseudocyst and a small portal vein thrombosis were observed by abdominal computed tomography. The portal vein thrombosis grew rapidly on the 14th day despite the administration of heparin sodium. She underwent the percutaneous drainage guided by computed tomography for the pancreatic pseudocyst. Pseudocystography showed filling with contrast agent of the portal vein through a fistulous tract. The pancreatic pseudocyst successfully drained away and the portal vein thrombosis disappeared after the drainage.
