PMC1266404_01
ERCP on presentation showing a dilated MPD and cystic lesions in the distal region of the pancreas.
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F1
ERCP confirmed these findings, and no extraluminal leakage of the contrast medium was observed (Figure 1).
Abdominal CT just prior to surgery showing distinct swelling of the pancreas and the gastric wall, causing the border between the two organs to be unclear.
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F2
Distinct swelling of the pancreas and thickening of the gastric wall were subsequently observed by abdominal CT (Figure 2), which indicated a mild post-ERCP pancreatitis.
Gastroscopy just prior to surgery showing a small ulcer producing a mucinous discharge into the body of the stomach.
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F3
Gastroscopy performed for the assessment of gastric wall thickness revealed a small ulceration in the body of the stomach (Figure 3), which was accompanied by a mucinous discharge suggesting the presence of a fistula opening into the MPD.
A cross-section of the pancreatogastric fistula (Hematoxylin and Eosin stain x 40). The fistula was significantly infiltrated with neutrophils and showed no evidence of neoplastic infiltration.
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F4
Light microscopy examination revealed inflammatory cellular infiltration consisting mainly of neutrophils around a pancreatogastric fistula which had no neoplastic epithelia (Figure 4).