Pancreatico-psoas fistula: a rare complication of acute pancreatitis

Abstract

The authors present a case of post endoscopic retrograde cholangio-pancreatography acute pancreatitis complicated by a pancreatico-psoas fistula, as well as reviewing similar previously published cases. The patient had a fluctuating clinical course over 4 months, developing multiple life-threatening complications including portal vein thrombosis, gastrointestinal bleeding, aspiration pneumonia and acute kidney injury on a background of chronic kidney disease. The authors followed the long-held surgical principle of draining sepsis and avoiding surgical intervention. The fistula dried up with conservative management and time also allowed portal venous collateral formation with resolution of his ascites.

Figure 1

(A) demonstrates the site of the fistula as indicated by the asterisk, lateral to the femoral artery. Note the large volume ascites which on no occasion had raised amylase levels. (B) demonstrates the fistula track as indicated by the asterisk, adjacent to the psoas muscle.

Figure 2

Proteolytic fluid from a pancreatic pseduocyst can extend into the iliopsoas compartment beneath the inguinal ligament; this path of spread occurs via the inferior portion of the anterior pararenal space, which communicates freely with the posterior pararenal space.