Pancreatico-Pleural Fistula – from Diagnosis to Management. A Case Report

Abstract

Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fistula is rare. Here we report a case of massive pleural effusion secondary to a fistula in the left hemi-diaphragm, between a pancreatic pseudocyst and the left pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. This fistula developed after several episodes of un-investigated acute pancreatitis. The pleural effusion was treated by three thoracocenteses, without recurrence.

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]. Alcoholrelated chronic pancreatitis is the leading cause of fistula formation [1][2][3][4][5][6][7].…”

“…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.…”

“…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.…”

“…There is no cut-off point for amylase level. 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].…”

“…PPF can be treated medically, endoscopically and surgically [1][2][3][4][5][6]. Medical treatment with octreotide to decrease pancreatic secretions accompanied by total parenteral nutrition has been successful in 31%-65% of the cases.…”