| Pancreatic pseudocyst-inferior vena cava fistula causing caval stenosis, left renal vein thrombosis, subcutaneous fat necrosis, arthritis and dysfibrinogenemia. | |
| | |
MedLine Citation:
|
PMID: 21090560 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
AIM: We describe the case of a 38 year old man, with a story of alcohol abuse, who developed a very painful nodular subcutaneous fat necrosis, fever and polyarthritis, denying any abdominal symptoms due to a pancreatic pseudocyst-inferior vena cava fistula. MATERIAL OF STUDY: The authors discuss the unusual and protracted course with intermittent hyperamylasemia and hyperlipasemia related to clinical manifestations such as subcutaneous fat necrosis, polyarthritis, pleural effusion and dysfibrinogenemia, and vascular complications as inferior vena cava stenosis and left renal vein thrombosis without abdominal symptomatology. RESULTS: After ultrasonograms and CT Scans showing a 3-4 cm cyst at the pancreatic head with a solid bud protruding into the pseudocystic cavity, and an ERCP showing a communication between the pancreatic duct and the pseudocyst but failing in demonstrating the vascular fistula, the patient underwent a Roux-en-y pseudocyst-jejunostomy and suture of the caval communication leading to complete recovery with normalization of laboratory findings. DISCUSSION: In our case, the locally sclerosing activity of the enzymes in the endothelium led to a communication between the inferior vena cava and the pseudocyst and to a complete thrombosis of the left renal vein and to a stenosis of the inferior vena cava itself The fluctuance of the symptomatology severity was probably due to an intermittent opening of the passage between pseudocyst and vena cava. Such a clinical case, to the author knowledge, has never been reported. CONCLUSION: When in presence of very high levels of amylasemia and lipasemia in spite of the paucity of abdominal symptomatology, and the onset of unusual complications such as panniculitis, pleural effusion, arthritis and coagulative disorders, a pancreatic pseudocyst-inferior vena cava fistula should be kept in consideration during diagnosis. |
| | |
Authors:
|
Alberto Porcu; Pier Luigi Tilocca; Luca Pilo; Francesca Ruiu; Giuseppe Dettori |
Publication Detail:
|
Type: Case Reports; Journal Article |
Journal Detail:
|
Title: Annali italiani di chirurgia Volume: 81 ISSN: 0003-469X ISO Abbreviation: Ann Ital Chir Publication Date: 2010 May-Jun |
Date Detail:
|
Created Date: 2010-11-24 Completed Date: 2010-12-23 Revised Date: 2011-08-25 |
Medline Journal Info:
|
Nlm Unique ID: 0372343 Medline TA: Ann Ital Chir Country: Italy |
Other Details:
|
Languages: eng Pagination: 215-20 Citation Subset: IM |
Affiliation:
|
Department of General Surgery, University of Sassari, Faculty of Medicine, Sassari, Italy. albporcu@hotmail.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Afibrinogenemia / etiology* Alcoholism / complications Arthritis / etiology* Constriction, Pathologic / etiology, surgery Fat Necrosis / etiology* Humans Male Pancreatectomy Pancreatic Fistula / diagnosis, etiology*, surgery Pancreatic Pseudocyst / complications*, diagnosis, surgery Renal Veins* / pathology, surgery Risk Factors Subcutaneous Fat / pathology*, surgery Treatment Outcome Vascular Fistula / diagnosis, etiology*, surgery Vascular Surgical Procedures / methods Vena Cava, Inferior* / pathology, surgery Venous Thrombosis / etiology*, surgery |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Unusual location of hydatid cyst: the posterior leaflet of tricuspid valve.
Next Document: Single port laparoscopically assisted hysterectomy with the TriPort system. A case report and review...