Pancreatic pseudocyst-inferior vena cava fistula causing caval stenosis, left renal vein thrombosis, subcutaneous fat necrosis, arthritis and dysfibrinogemia


COD: 03_2010_215-220 Categorie: ,

Alberto Porcu, Pier Luigi Tilocca, Luca Pilo, Francesca Ruiu, Giuseppe Dettori

Ann. Ital. Chir., 2010; 81: 215-220

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subcutaneous fat necrosis, fever and polyarthritis, denying any abdominal symptoms due to a pancreatic pseudocyst-inferior
vena cava fistula.
MATERIAL OF STUDY: The authors discuss the unusual and protracted course with intermittent hyperamylasemia and
hyperlipasemia related to clinical manifestations such as subcutaneous fat necrosis, polyarthritis, pleural effusion and dysfibrinogenemia,
and vascular complications as inferior vena cava stenosis and left renal vein thrombosis without abdominal
RESULTS: After ultrasonograms and CT Scans showing a 3-4 cm cyst at the pancreatic head with a solid bud protruding
into the pseudocystic cavity, and an ERCP showing a communication between the pancreatic duct and the pseudocyst
but failing in demonstrating the vascular fistula, the patient underwent a Roux-en-y pseudocyst-jejunostomy and
suture of the caval communication leading to complete recovery with normalization of laboratory findings.
DISCUSSION: In our case, the locally sclerosing activity of the enzymes in the endothelium led to a communication between
the inferior vena cava and the pseudocyst and to a complete thrombosis of the left renal vein and to a stenosis of the
inferior vena cava itself. The fluctuance of the symptomatology severity was probably due to an intermittent opening of
the passage between pseudocyst and vena cava. Such a clinical case, to the author knowledge, has never been reported.
CONCLUSION:When in presence of very high levels of amylasemia and lipasemia in spite of the paucity of abdominal
symptomatology, and the onset of unusual complications such as panniculitis, pleural effusion, arthritis and coagulative
disorders, a pancreatic pseudocyst-inferior vena cava fistula should be kept in consideration during diagnosis.