ENDOSCOPIC TREATMENT OF SUBCUTANEOUS FAT NECROSIS SECONDARY TO PANCREATIC-VASCULAR FISTULA - A CASE-REPORT

The treatment of pancreatico-vascular fistula leads to medical measure s (parenteral nutrition and somatostatine). In case of failure, surger y of pancreatic prosthesis can be a good alternative. Patient and meth od. - We report the case of a 68-year-old man who presented a pancreat ic tumor with a pancreato-vascular fistula and a Weber-Christian syndr ome. Pancreatic enzymes levels at the admission were high: amylasemia 2,470 IU/L (N < 110) and lipasemia 11,700 IU/L (N < 220). The treatmen t 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 panc reatography. During this examination, we put a 7 French diameter prost hesis through the Wirsung stenosis. Results. - No problem arose after endoscopy: since the day after the endoscopy, pancreatic enzymes decre ased by half and become normal in 4 days; arthralgias and cutaneous in juries, 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 cal l replace the surgical treatment of pancreato-vascular fistula with re good efficacy. (C) 1998, Elsevier, Paris.