We encountered a very rare case of biliopancreatic
fistula with portal vein
thrombosis caused by
pancreatic pseudocyst. A 57-year-old man was referred to our hospital because of
abdominal pain,
obstructive jaundice, and portal vein
thrombosis due to
acute pancreatitis. Computed tomography showed a 7-cm-diameter pseudocyst around the superior mesenteric vein extending towards the pancreatic head, dilatation of the intrahepatic bile duct, and portal vein
thrombosis. Endoscopic retrograde pancreatography revealed a main pancreatic duct with a pseudocyst communicating with the common bile duct. After pancreatic
sphincterotomy, a 7-F tube
stent was endoscopically placed into the pseudocyst. However, a 6-F nasobiliary tube could not be inserted into the bile duct because the
fistula had a tight
stenosis. Subsequently, the patient's
abdominal pain improved, the
pancreatic cyst disappeared, and the serum
amylase level normalized. Two months after the endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage was required because the patient's
jaundice became aggravated. Two weeks after the
choledochojejunostomy, the patient left the hospital in good condition. A follow-up computed tomography showed cavernous transformation of the portal vein and no
pancreatic pseudocyst. The patient remains asymptomatic for 2 years and 7 months after surgery. Biliary drainage may be necessary for biliopancreatic
fistula with
obstructive jaundice in addition to
pancreatic cyst drainage. Biliopancreatic
fistula can be treated by endoscopic procedure in some cases; however, surgical treatment should be required in cases that are impossible to insert a biliary
stent because of hard
stricture.