PPP Syndrome Caused by Pancreatic Pseudocyst with Fistula to Inferior Vena Cava

Tatarelyte R1, Stonkus S1, Kapacinskaite N1, Jurgaitis J2*, Slepavicius A3, Gvazdaitis M4, Bertasius P5 and Tevelyte I5

1Department of Diagnostics of Internal Diseases, Klaipeda University Hospital, Lithuania
2Department of Abdominal Surgery, Klaipeda University Hospital, Lithuania
3Department of Abdominal and Endocrine Surgery, Klaipeda University Hospital, Lithuania
4Department of Radiology, Klaipeda University Hospital, Lithuania
5Lithuanian University of Health Sciences, Lithuania

^*Correspondance to: Jonas Jurgaitis 

 PDF  Full Text DOI: 10.25107/2474-1647.3648

Abstract

Introduction: In rear cases pancreatitis can manifest in extra-abdominal symptoms as polyarthritis and panniculitis leading to PPP syndrome. Case Report: 34-year-old man was diagnosed with a pancreatic pseudocyst draining to Inferior Vena Cava. Because of the damage done by circulating pancreatic enzymes intraosseous fat necrosis, polyarthritis, panniculitis symptoms appeared. Surgical closing of the fistula was performed. As a result, pancreatitis and panniculitis were successfully treated while arthritis symptoms remained. Discussion: Most often PPP syndrome appears due to the pancreatitis. The exact pathophysiological chain of the development of extra abdominal symptoms is not clear, however some authors suggest it might be the result of pancreatic lipase entering bloodstream. Pancreatic enzymes circulating in the blood tend to damage adipose tissue in the lower limbs causing the signs of panniculitis. The manifestation of arthritis differs depending on the clinical case as it can involve different joints, vary in number and symmetry. The best outcomes are usually achieved by performing the surgery, while conservative treatment lacks effectiveness. Conclusion: Pancreatitis, pancreatic polyarthritis and panniculitis simultaneously are diagnosed in rare cases. However, it is important to include PPP syndrome into early diagnostics to improve the prognosis of the condition.

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Cite the article

Tatarelyte R, Stonkus S, Kapacinskaite N, Jurgaitis J, Slepavicius A, Gvazdaitis M, et al. PPP Syndrome Caused by Pancreatic Pseudocyst with Fistula to Inferior Vena Cava. Clin Surg. 2023; 8: 3648..