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CASE REPORT Table of Contents   
Year : 2020  |  Volume : 30  |  Issue : 4  |  Page : 529-532
Where there is pancreatic juice, there is a way: Spontaneous fistulization of severe acute pancreatitis-associated collection into urinary bladder


1 Department of Radiology, UTHSCSA, Texas, USA
2 Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
3 East Suffolk and North Essex NHS Foundation Trust, Dallas, Texas, USA, USA
4 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA

Correspondence Address:
Dr. Yashant Aswani
Department of Radiology, University of Texas Health Science Center, San Antonio, Texas
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijri.IJRI_349_20

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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.


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