Spontaneous rupture of a pancreatic pseudocyst into the portal vein

An unusual complication of pancreatic pseudocyst is reported. A 47-year-old woman with chronic liver disease and a history of recurrent pancreatitis died of fulminant, gram-negative septic shock. Acute, bilateral thigh cellulitis with tissue culture positive for Escherichia coli was the only potential infectious source identified. Autopsy revealed a pseudocyst in the head of the pancreas that had eroded into the portal vein, with embolization of mucoid cyst material into intrahepatic portal vein branches. Fibrous organization and recanalization of some of the occluded portal vein branches indicated that this process had been present for weeks to months and was therefore not the direct cause of death. The literature on this unusual complication of pancreatic pseudocyst is also reviewed.