Acute pancreatitis is associated with numerous complications. Pancreatic-portal vein fistula (PPVF) is an exceptionally rare and diagnostically challenging example [1] [2]. A 63-year-old man was admitted due to abdominal pain, weight loss, newly diagnosed diabetes, and elevated liver enzymes. Contrast-enhanced computed tomography revealed acute pancreatitis with fluid exudation and a necrotic collection in the head of the pancreas, accompanied by attenuation of fluid in the portal vein. Subsequent magnetic resonance cholangiopancreatography raised suspicion of PPVF.

Endoscopic retrograde cholangiopancreatography (ERCP) identified a stenosis in the pancreatic duct (PD) at the head of the pancreas, associated with an upstream fluid collection and a fistula into the portal vein. The PD was not visible as the contrast injection passed into the portal vein ([Video 1]). The therapeutic intervention included pancreatic sphincterotomy with dilation of the PD stenosis with a 6-mm balloon catheter. Two 7 cm × 7 Fr double-pigtail stents were positioned within the fluid collection. The patient developed septicemia, which was treated with antibiotics. The patient was discharged after 45 days of hospitalization.