Endoscopic treatment of subcutaneous fat necrosis secondary to pancreatic-vascular fistula: a case report.

The treatment of pancreatico-vascular fistula leads to medical measures (parenteral nutrition and somatostatine). In case of failure, surgery of pancreatic prosthesis can be a good alternative. Patient and method. - We report the case of a 68-year-old man who presented a pancreatic tumor with a pancreato-vascular fistula and a Weber-Christian syndrome. Pancreatic enzymes levels at the admission were high: amylasemia 2,470 IU/L (N < 110) and lipasemia 11,700 IU/L (N < 220). The treatment consisted in total parenteral nutrition and somatostatin (100 mu g x 3/day). Because we noted neither clinical nor biological improvement after IO days of treatment, we performed an endoscopic retrograde pancreatography. During this examination, we put a 7 French diameter prosthesis through the Wirsung stenosis. Results. - No problem arose after endoscopy: since the day after the endoscopy, pancreatic enzymes decreased by half and become normal in 4 days; arthralgias and cutaneous injuries, both caused by cytosteatonecrosis, disappeared respectively in 5 and IO days. There is no evidence of subsequent recurrence after 3 months of follow-up. Conclusion. - Pancreatic endoscopic prothesis call replace the surgical treatment of pancreato-vascular fistula with re good efficacy. (C) 1998, Elsevier, Paris.