Portal vein embolization for pancreatic-portal vein fistula in acute pancreatitis: interventional treatment of a rare complication

Summary A 70-year-old male with recurrent alcohol-related pancreatitis and prior Roux-en-Y gastric bypass presented with complicated acute pancreatitis. Imaging revealed ascites, portal vein thrombosis with cavernous transformation, and a pancreatic pseudocyst adjacent to the portal vein. Subsequent MRCP demonstrated complete resolution of the thrombosis and confirmed a pancreatic–portal vein fistula (PPVF) with intravascular pancreatic secretions. Due to altered anatomy, endoscopic treatment was not feasible. A percutaneous approach was performed, including transhepatic drainage across the portal vein, pseudocyst, and pancreatic duct for decompression, followed by definitive portal vein embolization using an Amplatzer plug and Histoacryl/Lipiodol. At 4-month follow-up, MRI confirmed fistula closure and the patient remained clinically stable with preserved liver function.