PMC5577032_01
Computed tomography (CT) scan at initial presentation demonstrating acute necrotizing pancreatitis.
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A computed tomography scan with contrast of his abdomen at presentation showed evidence of acute necrotizing pancreatitis with extensive portal vein thrombosis (Figure 1).
CT scan 1 week after initial presentation demonstrating necrotizing pancreatitis with associated peripancraetic collection with multiple air locules within the collection, suggestive of a pancreaticoduodenal fistula.
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Subsequent computed tomography imaging revealed a peri-pancreatic collection with extension along the mesentery (Figure 2).
Endoscopy demonstrating pancreatic debris flowing into the duodenum after clot removal, confirming pancreaticoduodenal fistulization.
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On removal of the clot, there was evidence of a spontaneous pancreaticoduodenal fistula, with the flow of necrotic pancreatic contents into the duodenum (Figure 3).
Digital subtraction angiography demonstrating successful coil embolization of the gastroduodenal artery psuedoaneurysm.
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Angiography demonstrated a gastric artery psuedoaneurysm with spasm suggesting recent bleed, and this was successfully treated with coil embolization (Figure 4).
Fistulogram performed by injecting contrast into indwelling drain within the inferior aspect of pancreatic collection. Contrast flow into stomach confirmed fistulous communication.
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The pancreaticoduodenal fistula was also subsequently confirmed with a fistulogram (Figure 5).