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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2020; 30(04): 529-532
DOI: 10.4103/ijri.IJRI_349_20
Case Report

Where there is pancreatic juice, there is a way: Spontaneous fistulization of severe acute pancreatitis-associated collection into urinary bladder

Yashant Aswani
Department of Radiology, UTHSCSA, Texas, USA
,
Shehbaz MS Ansari
Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
,
Ulhaas S Chakraborty
East Suffolk and North Essex NHS Foundation Trust, Dallas, Texas, USA
,
Priya Hira
Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
,
Sudeshna Ghosh
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Pancreatic fluid collections (PFC) are notorious for their extension beyond the normal confines of the pancreatic bed. This distribution is explained by dissection along the fascial planes in retroperitoneum due to the digestive enzymes within the PFC. In genitourinary track, PFCs have been described to involve the kidneys and the ureters. We report a case of severe acute necrotizing pancreatitis in a 28-year-old male, chronic alcoholic, who on readmission developed features of cystitis. The urine was turbid but did not show significant bacteriuria. Close location of the PFC near the urinary bladder (UB) prompted evaluation of urinary lipase and amylase. Elevated urinary enzyme levels suggested a Pancreatico-vesical fistula, conclusive demonstration of which was established by CT cystography. Percutaneous drainage of the necrosum and stenting of pancreatic duct led to spontaneous healing of the pancreatico-vesical fistula. Our case reiterates the remarkable property of pancreatic enzymes to dissect the fascial planes which is demonstrated by decompression of PFC via UB causing spontaneous Pancreatico-vesical fistula. Further, presence of main pancreatic duct fistulization should prompt endoscopic-guided stenting to obliterate the communication with the fistula and accelerate healing.

Keywords

Acute necrotizing pancreatitis - pancreatic fistula - urinary bladder fistula


Publication History

Received: 12 May 2020

Accepted: 31 August 2020

Article published online:
14 July 2021

© 2020. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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