[Endoscopic treatment of subcutaneous fat necrosis secondary to pancreatic-vascular fistula: apropos of a case].

Abstract

PATIENT AND METHOD:

We report the case of a 68-year-old man who presented a pancreatic tumor with a pancreato-vascular fistula and a Weber-Christian syndrome. Pancreatic enzymes levels at the admission were high: amylasemia 2,470 IU/L (N < 110) and lipasemia 11,700 IU/L (N < 220). The treatment consisted in total parenteral nutrition and somatostatin (100 micrograms x 3/day). Because we noted neither clinical nor biological improvement after 10 days of treatment, we performed an endoscopic retrograde pancreatography. During this examination, we put a 7 French diameter prosthesis through the Wirsung stenosis.

RESULTS:

No problem arose after endoscopy: since the day after the endoscopy, pancreatic enzymes decreased by half and become normal in 4 days; arthralgias and cutaneous injuries, both caused by cytosteatonecrosis, disappeared respectively in 5 and 10 days. There is no evidence of subsequent recurrence after 3 months of follow-up.

CONCLUSION:

Pancreatic endoscopic prosthesis can replace the surgical treatment of pancreato-vascular fistula with a good efficacy.

• Authors: D Reynaud, L Alric, J Escourrou, E Bonnet, M Duffaut
• Journal: La Revue de medecine interne (Rev Med Interne) Vol. 19 Issue 2 Pg. 123-7 (Feb 1998) ISSN: 0248-8663 [Print] France
• Vernacular Title: Traitement endoscopique d'une cytostéatonécrose secondaire à une fistule pancréaticovasculaire: à propos d'un cas.
• PMID: 9775127 (Publication Type: Case Reports, Comparative Study, English Abstract, Journal Article)

Chemical References

• Amylases

Topics

• Aged
• Amylases (blood)
• Cholangiopancreatography, Endoscopic Retrograde
• Clinical Enzyme Tests
• Constriction, Pathologic (therapy)
• Endoscopy
• Humans
• Male
• Pancreatic Ducts
• Pancreatic Fistula (complications, diagnosis, therapy)
• Panniculitis, Nodular Nonsuppurative (etiology, therapy)
• Prosthesis Implantation
• Vascular Fistula (complications, diagnosis, therapy)
• Vena Cava, Inferior