Management of Pancreaticopleural Fistulas Secondary to Chronic Pancreatitis

Abstract

Introduction:Pancreaticopleural fistula is a rare complication of chronic pancreatitis. Objective:To describe pancreaticopleural fistula due to chronic pancreatitis and perform an extensive review of literature on this topic. Methods:Comprehensive narrative review through online research on the databases Medline and Lilacs for articles published over the last 20 years. There were 22 case reports and four case series selected. Results:The main indication for surgical treatment is the failure of clinical and/or endoscopic treatments. Surgery is based on internal pancreatic drainage, especially by means of pancreaticojejunostomy, and/or pancreatic resections. Conclusion:Pancreaticopleural fistula is a rare complication of chronic pancreatitis and the Frey procedure may be an appropriate therapeutic option in selected cases when clinical and endoscopic treatments are unsuccessful.

Pancreaticopleural Fistula: A Rare Presentation and a Rare Complication

“…Pancreaticopleural fistula occurs in less than 1% of patients with acute pancreatitis 0.4% of patients with chronic pancreatitis and in 4.5% of patients with pseudocyst [1][2][3][4]. Pancreatic pseudocyst is defined as an abnormal collection of pancreatic secretions contained within a non-epithelial wall, that is composed primarily of granular and fibrous tissue [4].…”

“…Pancreatic pseudocyst is defined as an abnormal collection of pancreatic secretions contained within a non-epithelial wall, that is composed primarily of granular and fibrous tissue [4]. Alcoholrelated chronic pancreatitis is the leading cause of fistula formation [1][2][3][4][5][6][7]. However, PPF can occur as a result of gallstone pancreatitis, idiopathic pancreatitis, trauma, or congenital anomalies of the pancreatic duct.…”

“…If the pancreatic pseudocyst ruptures anteriorly, pancreaticperitoneal fistula will occur and manifests as ascites. On a very rare occasion, communication with the bronchial tree, esophagus, or the pericardium has also been reported with the latter manifesting as pericardial effusion [1][2].…”

“…However, it can occur on the right side (19%-40%) or bilaterally (14%-17%) [1]. Presenting symptoms are mainly pulmonary related, with dyspnea being the most common presenting symptom in 65%-76% of the cases [1][2][3][4][5][6]8,9]. Abdominal symptoms were reported in 24% of the cases.…”

“…However, it is usually significantly elevated with a mean amylase level above 10,000 U/L [1,4]. Of note, serum amylase has no role in the diagnosis [2]. Other causes of amylase-rich pleural effusion include parapneumonic effusion, pulmonary tuberculosis esophageal rupture and malignancies like leukemia, lymphoma and gynecological malignancies [1][2].…”