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

Oh, Young S.; Edmundowicz, Steven A.; Jonnalagadda, Sreenivasa S.; Azar, Riad R.

doi:10.1007/s10620-006-3073-7

Cited by 53 publications

(64 citation statements)

References 28 publications

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“…(1,9,11,12) In general, PPF formation is seldom associated with acute pancreatitis, and occurs most commonly in a background of chronic recurrent pancreatitis secondary to excessive alcohol intake. (1,4,11,12) The presence of pancreatic pseudocysts was noted in 43%-79% of patients with PPF. (1,5,11,12) There is often a delay in diagnosis of PPF due to the misleading predominance of thoracic symptoms over abdominal symptoms.…”

Section: Clinical Fe Aturesmentioning

confidence: 99%

“…(1,4,11,12) The presence of pancreatic pseudocysts was noted in 43%-79% of patients with PPF. (1,5,11,12) There is often a delay in diagnosis of PPF due to the misleading predominance of thoracic symptoms over abdominal symptoms. In the literature, the most common presenting complaint reported was dyspnoea, which was present in 65%-76% of cases.…”

Section: Clinical Fe Aturesmentioning

confidence: 99%

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Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

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Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.

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Section: Clinical Fe Aturesmentioning

confidence: 99%

Section: Clinical Fe Aturesmentioning

confidence: 99%

Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

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“…The formation of pancreaticopleural fistula that incidence reported about 0.4%~4.5% was uncommon complicated of chronic pancreatitis [4]. Pseudocyst is a fibroinflammatory ring is formed around the collection.…”

Section: Discussionmentioning

confidence: 99%

Bloody Pancreatic Pleural Effusion: A Case Report

Wang¹,

Huang²,

Chung³

et al. 2016

Ann Clin Lab Res

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A 54-year-old male presented with massive left bloody pleural effusion. Thoracocentasis revealed high level of amylase and lipase. The abdomen computed tomogram (CT) scan showed a pseudocyst of pancreatic tail and necrotizing pancreatitis with walled off necrosis formation that encroaching splenic vein and esophagus with upward extension to middle mediastinum and bilateral pleural effusion. The other differential diagnosis such as oesophageal perforation and certain neoplastic processes should be considered. After surgery of distal pancreatectomy with splenectomy, the symptom relieved. Case HistoryA 54-year-old male presented with left anterior chest tightness and shortness of breath for days. He had the history of acute pancreatitis two months ago. He is a chronic alcoholic drinking about 300 ml/day of 58 percentage alcohol in kaoling liquor. Chest X-ray showed left massive pleural effusion with right-deviated trachea ( Figure A). The results of bloody pleural effusion analysis of left side were as below: white blood cells (WBC): 900/ul with neutrophil predominant, red blood cells (RBC): 540000/ul. Lactate dehydrogenase (LDH): 483 U/L, total protein: 3.9 g/dl, hematocrit: 0.7%, amylase: 3043 U/L, lipase: 151800 U/L. Gram staining and culture showed negative finding. Cytology for malignancy was negative. The serum of LDH: 160 U/L, total protein: 6.6 g/dl. Abdominal CT scan revealed a pseudocyst of pancreatic tail and poor enhancing region involving pancreatic tail with large amount of walled-off necrosis formation, which encroaching splenic vein and esophagus with upward extension to middle mediastinum and large amount of bilateral pleural effusion is also noted, suspect pancreatitis related (Figures B and C). Panendoscopy revealed duodenal polyps. Esophagography and aortography showed no leakage of contrast.

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“…While conservative management with inhibition of pancreatic secretion with octreotide may achieve closure of fistula in 31% to 45% of cases, surgery leads to healing in 80% to 90% of cases. [2][3][4][5][6] There are very few documented cases of pancreaticopleural fistula presenting as non-resolving unilateral pleural effusion. 7 PPF presenting as right-sided pleural effusion with intradiaphragmatic fistula rather than fistula through the diaphragmatic hiatus 8,9,10 is rarer still.…”

Section: Final Diagnosismentioning

confidence: 99%

“…The classical presentation is that of an alcoholic middle-aged man who presents with respiratory distress and then found to have left-sided pleural effusion. 6 Biliary duct obstruction constitutes the major aetiological factor in children. 8,11 Although rare, right-sided or bilateral pleural effusion is also seen in such cases.…”

Section: Final Diagnosismentioning

confidence: 99%

Pancreaticopleural Fistula- A Rare Cause of Haemorrhagic Pleural Effusion

Baruah¹,

Dutta²,

Paul³

et al. 2017

jemds

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HOW TO CITE THIS ARTICLE: PRESENTATION OF CASEA 10-year-old boy presented with complaints of pain abdomen for 8 months, which had increased in severity for 15 days prior to admission along with fever, difficulty in respiration and right-sided dull aching chest pain. On examination, he was pale and tachypnoeic with a normal nutritional status. The trachea was shifted towards left, stony dullness was noted on percussion and breath sounds were decreased on the right side of the chest. Tenderness was present over epigastrium and right hypochondrium. CLINICAL DIAGNOSISClinically, the case was diagnosed as right-sided bacterial pleural effusion with chronic abdominal pain. Further investigations were planned to confirm the diagnosis and to find out the aetiology. DIFFERENTIAL DIAGNOSISDifferential diagnoses can be tubercular pleural effusion or haemorrhagic pleural effusion (rare). Differential diagnoses of pain abdomen can be hepatic abscess, right subphrenic abscess, pancreatic pseudocyst and acute or chronic pancreatitis. So immediate chest x-ray and pleural tapping were planned. PATHOLOGICAL AND RADIOLOGICAL DISCUSSIONRoutine blood examination showed Hb 12.3 gm%, TLC 18,800/mm3 with 87% neutrophils and ESR 30 mm AEFH. Chest X-ray showed total homogenous opacification of the right hemithorax with gross mediastinal shift towards the left. On aspiration, pleural fluid was found to be haemorrhagic. Pleural fluid analysis showed protein 3.8 gm/dL, sugar 40 mg/dL, cell count 580 cells/cumm, mostly lymphocytes and presence of plenty of RBCs. There were no malignant cells. ADA was normal. Culture of pleural fluid showed growth of Acinetobacter baumannii. Tuberculin test was negative. PT, APTT, INR and platelet count were normal. Common causes of haemorrhagic pleural effusion are malignant effusion (most commonly Lymphoma), traumatic effusion, tubercular effusion or bleeding diathesis. The patient was started empirically on Vancomycin, which was changed to Imipenem later as per the sensitivity report.

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

Cited by 53 publications

References 28 publications

Diagnosis and management of pancreaticopleural fistula

Diagnosis and management of pancreaticopleural fistula

Bloody Pancreatic Pleural Effusion: A Case Report

Pancreaticopleural Fistula- A Rare Cause of Haemorrhagic Pleural Effusion

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