Endoscopic retrograde pancreatography with pancreatic stenting as a therapeutic approach for pancreatic-portal vein fistula

Background and Aims: Pancreatic-portal vein fistula (PPVF) is a rare condition characterized by an abnormal connection between the pancreatic duct and the portal vein. It is frequently associated with serious adverse events, including portal vein thrombosis and gastrointestinal bleeding. Although surgical intervention represents a therapeutic option, endoscopic retrograde pancreatography (ERP) with pancreatic stenting is a possible minimally invasive alternative for the management of PPVF. Methods: A 41-year-old patient with a history of severe alcoholic pancreatitis underwent ERP after imaging, which revealed rupture of the duct of Wirsung complicated by PPVF and abdominal fluid collections. A pancreatic sphincterotomy was performed, and an 8.5F × 12-cm pancreatic stent was placed. Results: The patient showed a marked improvement in clinical condition. Follow-up imaging demonstrated complete resolution of the PPVF and a significant reduction in pre-existing abdominal fluid collections, refractory to antibiotic and radiological/surgical treatments. Two months later, a second ERP confirmed fistula closure, and a 10F × 7-cm stent was placed to further reinforce the therapeutic outcome. Conclusions: ERP with pancreatic stenting proved to be an effective and minimally invasive treatment for PPVF, promoting fistula closure and significant improvement in abdominal fluid collections. This case underscores the potential of ERP as a viable alternative to surgery in select cases.