Pancreaticogastric Fistula Due to Infiltration of a Mixed Type
Intrapapillary Mucinous Neoplasia of the Pancreas
Andreas Minh Luu
Received: 8 May 2018 / Accepted: 15 May 2018
2018 The Society for Surgery of the Alimentary Tract
Background A 68-year-old asymptomatic patient was incidentally diagnosed with an intraductal papillary mucinous neoplasia
(IPMN) of the pancreas with a pancreaticogastric fistula. He had a history of a right sided nephrectomy due to a renal cell
carcinoma 9 years before. The patient underwent an uneventful total pancreatectomy and wedge resection of the stomach.
Methods The patient’s medical history was studied and compared to recent literature via PubMed.
Results Pathohistological evaluation confirmed a mixed type IPMN of an intestinal subtype with pancreaticogastric fistula.
Conclusion Pancreaticogastric fistula due to benign IPMN is extremely rare. Surgical resection including wedge resection of the
stomach is the treatment of choice.
Keywords Pancreaticogastric fistula
Intraductal papillary mucinous neoplasia
A 68-year-old male Caucasian patient was referred to our
clinic with a massive cystic lesion of the pancreas. A comput-
ed tomography of the abdomen was performed in a radiologic
practice as a follow-up investigation after a right-sided ne-
phrectomy due to a renal cell carcinoma 9 years before.
The patient was asymptomatic and free of any complaints.
Magnet resonance imaging revealed a massively dilated main
pancreatic duct with a cystic lesion in the pancreatic body
infiltrating the greater curvature of the stomach highly suspi-
cious for a pancreaticogastric fistula (Fig. 1). Upper GI endos-
copy confirmed infiltration of the stomach without evidence
for a malignancy in the biopsies. Laboratory parameters in-
cluding tumor markers carcinoembryonic antigen and carbo-
hydrate antigen 19–9wereunremarkable.
An uneventful total pancreatectomy and an en-block-
wedge resection of the stomach were performed subsequently.
Figure 2 demonstrates a view from the stomach with focus on
the pancreaticogastric fistula. Pathologic examination re-
vealed a mixed type main duct and side branch IPMN of an
intestinal subtype. Carcinoma cells were not identified. The
postoperative course was uneventful.
Fig. 1 Magnet resonance imaging of the abdomen (coronary view)
demonstrating the pancreaticogastric fistula (yellow arrow) between the
pancreas (P) and the stomach (S)
Each author meets the ICMJE criteria.
* Andreas Minh Luu
Department of General and Visceral Surgery, St. Josef Hospital,
Ruhr-University Bochum, Gudrunstraße 56,
44791 Bochum, Germany
Department of Radiology, St. Josef Hospital, Ruhr-University
Bochum, Bochum, Germany
Journal of Gastrointestinal Surgery