Year 2025 / Volume 117 / Number 10
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An elderly patient’s pancreatobiliary puzzle: unraveling diagnosis and treatment challenges

579-580

DOI: 10.17235/reed.2024.10125/2023

André Gonçalves, Carina Leal, Isabel Cotrim, Helena Vasconcelos,

Abstract
Pancreatobiliary fistulas associated withntraductal Papillary Mucinous Neoplasm (IPMN) are rare and present therapeutic challenges. The authors describe the clinical course of an 81-year-old woman presenting with acute cholangitis, ultimately diagnosed with IPMN involving secondary ducts with focal high-grade dysplasia. Initial manifestations included elevated inflammatory markers, cholestasis, and imaging findings of a pancreatic lesion. Endoscopic retrograde cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts, along a cystic cluster originating from the pancreas, fistulizing into the common bile duct. Despite initial endoscopic interventions, recurrent cholestasis persisted. Subsequent multidisciplinary evaluation led to a cephalic duodenopancreatectomy. This case underscores the rarity of pancreatobiliary fistulas associated with IPMNs and the subsequent therapeutic challenges. The absence of standardized treatment algorithms for such intricate cases emphasizes the importance of individualized approaches. The fluoroscopy image displaying a cystic cluster originating from the pancreas and showing fistulization into the common bile duct is a rare image presented in our report, unique to this case.
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Gonçalves A, Leal C, Cotrim I, Vasconcelos H. An elderly patient’s pancreatobiliary puzzle: unraveling diagnosis and treatment challenges. 10125/2023


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Publication history

Received: 28/11/2023

Accepted: 18/12/2023

Online First: 11/01/2024

Published: 10/10/2025

Article Online First time: 44 days

Article editing time: 682 days


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