Background: Pancreatic panniculitis is a rare condition that usually occurs in association with acute or chronic pancreatitis or pancreatic carcinoma. We report a case of pancreatic panniculitis revealing a pancreaticportal fistula and portal thrombosis.
Case report: A 79-year-old man was admitted for nodular panniculitis of the lower extremities without any digestive symptoms. Laboratory tests revealed very high plasma levels of amylase and lipase. A skin biopsy showed lobular panniculitis with ghost cells characteristic of pancreatic panniculitis. Rare pancreatic calcifications and portal thrombosis were seen on an abdominal CT scan and on endoscopic ultrasound examination of the pancreas. A pancreaticportal fistula was detected by endoscopic retrograde pancreatography. Finally, an endoscopic pancreatic prothesis was inserted in Wirsung's canal after failure of medical treatment (parenteral nutrition and octreotide). Skin lesions resolved and plasma pancreatic enzymes normalized.
Discussion: This case report is interesting because of the lack of gastrointestinal symptoms associated with pancreatic panniculitis and the discovery of a chronic pancreatitis of uncertain etiology. This case highlights the need to screen for pancreaticportal fistula and portal thrombosis, which are often associated with pancreatic panniculitis.