Pancreatic pleural effusion with a pancreaticopleural fistula diagnosed by magnetic resonance cholangiopancreatography and cured by somatostatin analogue treatment

Akahane, Takemi; Kuriyama, Shigeki; Matsumoto, Masami; Kikuchi, Eiryo; Kikukawa, Masaji; Yoshiji, Hitoshi; Masui, Kazuhiro; Fukui, Hiroshi

doi:10.1007/s00261-001-0144-2

Cited by 32 publications

(24 citation statements)

References 16 publications

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“…Performing CT immediately after ERCP has been reported to increase the sensitivity of CT in detecting pancreaticopleural fistulas (8), presumably because of the contrast injected directly in the pancreatic duct at the time of ERCP. Recently, MRCP has been shown to be useful in making the diagnosis (4,5,10,12,15). Although transabdominal ultrasound has been reported to visualize pancreaticopleural fistulas (21), overlying bowel gas and body habitus often preclude adequate visualization.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticopleural Fistula: Report of Two Cases and Review of the Literature

Edmundowicz

Jonnalagadda

et al. 2006

Dig Dis Sci

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Pancreaticopleural fistulas are a rare complication of pancreatitis. We report two cases from our institution and review 37 cases of pancreaticopleural fistulas identified in the literature. Endoscopic retrograde cholangiopancreatography was more sensitive compared to computed tomography in demonstrating pancreaticopleural fistulas (79% versus 43%, respectively). Medical therapy with total parenteral nutrition, octreotide, and/or chest tube placement was successful in resolving the pancreaticopleural fistula in up to 33% of cases. None of the patients who underwent pancreatic duct stent and/or nasopancreatic drain placement required surgical intervention. Endoscopic retrograde cholangiopancreatography is the initial test of choice when the diagnosis of pancreaticopleural fistula is suspected. Early endoscopic intervention with pancreatic duct stent placement is recommended given its high success rate in fistula closure. Medical therapies are useful adjuncts to endoscopic therapy, but rarely result in pancreaticopleural fistula closure alone. Surgical interventions should only be considered after failure of endoscopic and medical therapies.

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Section: Discussionmentioning

confidence: 99%

Pancreaticopleural Fistula: Report of Two Cases and Review of the Literature

Edmundowicz

Jonnalagadda

et al. 2006

Dig Dis Sci

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“…Computed tomography discloses the pseudocyst [80, 87]and the fluid-filled tract [100]and endoscopic retrograde cholangiopancreatography usually demonstrates the ductal disruption [97, 101]whilst magnetic resonance cholangiopancreatography can also demonstrate the pancreatic cyst and the fistula tract [102]. …”

Section: Internal Pancreatic Fistulae and Pancreatic Ascitesmentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

102

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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“…They have a dramatic effect on both basal and stimulated pancreatic exocrine secretions. 8 We think that by using these combined treatments, pancreatic surgery should be considered feasible when endoscopic treatment fails.…”

Section: Discussionmentioning

confidence: 99%

Hemothorax as the Clinical Presentation of a Pancreaticopleural Fistula: Report of a Case

et al. 2007

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Pancreaticopleural fistula is a rare complication of acute pancreatitis with pancreatic pseudocyst. We report the case of a 39-year-old man admitted for respiratory distress. Chest X-ray showed a pleural effusion, and thoracentesis yielded bloody fluid. Computed tomography (CT) scan showed a multiloculated pleural effusion and sagittal reconstruction revealed a fistulous tract between the pleura and a pancreatic pseudocyst. We treated the acute hemothorax complicating the pancreaticopleural fistula by performing urgent thoracotomy with the evacuation of blood and clots and lung decortication. We also gave the patient somatostatin and performed endoscopic retrograde cholangiopancreatography with sphincterotomy, and placed a pancreatic stent. The patient recovered well.

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Pancreatic pleural effusion with a pancreaticopleural fistula diagnosed by magnetic resonance cholangiopancreatography and cured by somatostatin analogue treatment

Cited by 32 publications

References 16 publications

Pancreaticopleural Fistula: Report of Two Cases and Review of the Literature

Pancreaticopleural Fistula: Report of Two Cases and Review of the Literature

Surgical Treatment of Pancreatic Fistula

Hemothorax as the Clinical Presentation of a Pancreaticopleural Fistula: Report of a Case

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