Gastroenterology Service, Walter Reed Army Medical Center, Washington, D.C.
We describe a case of pancreatic duct-portal vein fistula discovered by endoscopic retrograde cholangiopancreatography, with confirmatory computed tomography and angiographic studies. The fistula was associated with chronic pancreatitis that was complicated by recurrent gram-negative bacteremia and peripheral subcutaneous fat necrosis, although pancreatic pseudocyst was not present. Even though surgical treatment was recommended, medical complications precluded surgery and the patient recovered with supportive therapy only. Follow-up endoscopic retrograde cholangiopancreatography showed spontaneous closure of the fistulous connection.