GASTROPANCREATIC FISTULA WITH FISH-MOUTH SIGN

We report a 72-year-old female with several pancreatitis episodes, including infected pancreatic fluid collection(PFC) drained at another institution. She was referred due to dilation of main pancreatic duct(MPD) in imaging and communication with gastric antrum. Endoscopically, a fistulous orifice in the antrum was apparent, with gelatinous content; endoscopic ultrasound showed dilated MPD (40mm-body) with loss of interface with the stomach. MPD fine-needle aspiration revealed a mucinous content. Cytologic analysis confirmed high-grade IPMN. Although IPMN can fistulize, in this patient most likely resulted from a prior procedure, underlying the importance of correct workup prior to PFCs drainage to exclude cyst neoplasm.