Pancreatobiliary fistula caused by an intraductal papillary-mucinous neoplasm, for which two different operations were performed

Abstract

Two cases of pancreatobiliary fistulas caused by intraductal papillary-mucinous pancreatic neoplasms (IPMNs), for which two different operations were performed, are reported. Case 1 was an 80-year-old female admitted to the hospital with fever and jaundice. Since she had tachycardia-related heart failure preoperatively, she was not considered a candidate for a curative operation, and palliative hepaticojejunostomy was performed instead. A pancreatogastric fistula developed 4 months after surgery, and the patient died 8 months postoperatively. Autopsy findings revealed moderately dysplastic, intraductal papillary-mucinous adenoma, as well as pancreato-gastric and -jejunal fistulas. Case 2 was a 70-year-old female admitted to the hospital with jaundice. Since curative operation seemed feasible, a total pancreatectomy was performed. Pathological findings revealed intraductal papillary-mucinous carcinoma. The patient is still alive 9 months postoperatively. In patients with a pancreatobiliary fistula caused by IPMN, appropriate surgery should be performed as early as possible.