Pancreatic Pseudocyst-portal vein fistula with portal thrombosis and biliary obstruction: a rare complication of necrotising pancreatitis.

BACKGROUND

Pancreatic pseudocyst fistulation into the portal venous system is rare. This may cause portal-vein thrombosis, portal hypertension, and biliary obstruction, complicating diagnosis and treatment.

CASE: A 45-year-old man with alcohol-induced necrotizing pancreatitis developed jaundice, pain, and abnormal liver tests. Imaging revealed a 6-cm pancreatic head pseudocyst connected to the portal confluence and thrombosed portal and splenic veins. CT showed cavernous transformation and bile duct compression. Pancreatic pseudocyst-portal vein fistula (PPVF) with portal hypertension-related biliary obstruction was diagnosed. The bile duct stricture was stented endoscopically; anticoagulation was withheld due to variceal risk. Symptoms and labs normalized within a week. At 3 months, the pseudocyst regressed, and the bile duct remained patent.

CONCLUSION

PPVF should be considered when portal-vein thrombosis and pancreatic pseudocyst coexist. Characteristic imaging can often obviate invasive confirmation. Early multidisciplinary management, prioritizing endoscopic or percutaneous drainage and selective anticoagulation, allows for safe, effective treatment while avoiding high-risk surgery.