PMC9851798_01
(a) Coronal reformatted contrast-enhanced CT demonstrates a large necrotic tumor in the pancreatic tail with suspicion of a fistula extending to the left colic angle (white arrow). (b) Digital subtraction angiography of the splenic artery shows caliber irregularities of the proximal and middle thirds of the vessel and a 15 mm diameter pseudoaneurysm (black arrow) of the middle third of the artery, without contrast extravasation; in the normal segments, the splenic artery measures 4-5 mm of diameter. Coronal reformatted CT with maximal intensity projection before (c) and after (d) positive contrast injection through the drainage catheter (asterisk) placed in the necrotic pancreatic mass reveals a pancreatico-colic fistula (black arrowhead) responsible for a concomitant opacification of the left colon. Images were acquired after endovascular embolization with coils (white arrowhead).
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fig1
Three phase computerized tomography (CT) scan showed a hypodense air-containing mass measuring 8 cm x 8 cm x 7 cm in the tail of the pancreas suggestive of a necrotic tumor lesion, with infiltration of the colon splenic flexure and fistula (Figure 1(a)). Therapeutic angiography was performed, confirming the formation of a middle third splenic artery pseudoaneurysm without active bleeding on angiography (Figure 1(b)). A neoplastic pancreatic abscess fistulising into the colon (neoplastic pancreatico-colic fistula) was confirmed by CT imaging after positive contrast injection into the catheter (Figures 1(c) and 1(d)).