Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.

Journal Section:
Case Report
Keywords:
Magnetic resonance imaging, Pancreas, Intraductal papillary-mucinous neoplasm
1.
Ohashi K, Murakami Y, Maryuama M, et al: Four cases of mucous secreting pancreatic cancer. Prog Dig Endosc 1982;20:348–351.
2.
Sahani DV, Kadavigere R, Blake M, Fernandez-Del Castillo C, Lauwers GY, Hahn PF: Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations – correlation with MRCP. Radiology 2006;238:560–569.
[PubMed]
https://doi.org/10.1148%2Fradiol.2382041463
3.
Gupta R, Mortele KJ, Tatli S, et al: Pancreatic intraductal papillary mucinous neoplasms: role of CT in predicting pathologic subtypes. AJR Am J Roentgenol 2008;191:1458–1464.
[PubMed]
https://doi.org/10.2214%2FAJR.07.3302
4.
Koizumi M, Sata N, Yoshizawa K, et al: Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review. World J Surg Oncol 2005;3:70.
[PubMed]
https://doi.org/10.1186%2F1477-7819-3-70
5.
Okada K, Furuuchi T, Tamada T, et al: Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: report of a case. Surg Today 2008;38:371–376.
[PubMed]
https://doi.org/10.1007%2Fs00595-007-3630-5
6.
Ogawa H, Itoh S, Ikeda M, Suzuki K, Naganawa S: Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 2008;248:876–886.
[PubMed]
https://doi.org/10.1148%2Fradiol.2482071578
7.
Jung IS, Shim CS, Cheon YK, et al: Invasive intraductal papillary mucinous tumor of the pancreas with simultaneous invasion of the stomach and duodenum. Endoscopy 2004;36:186–189.
[PubMed]
https://doi.org/10.1055%2Fs-2004-814190
8.
Lee SE, Jang JY, Yang SH, Kim SW: Intraductal papillary mucinous carcinoma with atypical manifestations: report of two cases. World J Gastroenterol 2007;13:1622–1625.
[PubMed]
https://doi.org/10.3748%2Fwjg.13.6296
9.
Yamada Y, Mori H, Matsumoto S: Intraductal papillary mucinous neoplasms of the pancreas: correlation of helical CT and dynamic MR imaging features with pathologic findings. Abdom Imaging 2008;33:474–481.
[PubMed]
https://doi.org/10.1007%2Fs00261-007-9289-y
© 2010 S. Karger AG, Basel
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2010
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