INTERNAL PANCREATIC FISTULA IN A PATIENT WITH ACUTE DESTRUCTIVE PANCREATITIS ASSOCIATED WITH SYSTEMIC CONNECTIVE TISSUE DISEASES

Introduction. A pPancreatic fistula is an abnormal connection of pancreatic ductal epithelium with another epithelial surface. Pancreatic fistulas may occur as a complication of acute or chronic pancreatitis. The incidence of external and internal fistulas in the outcome of pancreatic necrosis ranges from 5 to 50%. Aim was to present for discussion a clinical case of a female patient with acute pancreatitis complicated by pseudocysts and an internal pancreatic fistula, associated with systemic connective tissue diseases, as well as the results of diagnosing and the treatment options chosen. Material and Methods. A patient with a history of acute pancreatitis and connective tissue diseases. The article presents the case history, clinical manifestations, examination findings underlying the concept of patient management, and minimally invasive diagnostic and therapeutic manipulations. Results and Discussion. Diagnostic measures revealed bilateral hydrothorax, pancreatic pseudocysts (including mediastinal localization), and an internal pancreatic fistula. Conservative treatment with minimally invasive interventions was chosen. Conclusions. The clinical case presented illustrates the variability of the late complications of acute pancreatitis; a high therapeutic value of the conservative treatment of the patient in combination with pancreaticoduodenal stenting; great opportunities of multimodal instrumental diagnostic methods in identifying in identifying and precisely localizing the internal pancreatic fistula and assessing the associated pathologies; and the necessity of interrelations across all the diagnostic and clinical services.