Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: a case report

Miyachi, Akiko; Kikuyama, Masataka; Matsubayashi, Yuji; Kageyama, Fujito; Sumiyoshi, Shinichi; Kobayashi, Yoshimasa

doi:10.1016/s0016-5107(03)02719-6

Cited by 33 publications

(36 citation statements)

References 10 publications

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“…(10) ERCP enables the identification of pancreatic duct strictures and stones downstream from the fistula, which can then be treated using pancreatic sphincterotomy, balloon dilatation, stent placement or stone extraction with or without extracorporeal lithotripsy. (20)(21)(22)(23) The aim of stent placement is to achieve decompression of the PD by creating a pathway of least resistance for pancreatic secretions to flow into the duodenum. If possible, the stent should also bridge the site of ductal disruption, thus mechanically blocking the fistula lumen, in order to allow healing.…”

Section: Diagnosis and Investig Ationsmentioning

confidence: 99%

“…(25,26) Endoscopic placement of a nasopancreatic drain with application of low intermittent suction has also been reported to facilitate the resolution of PPF. (12,(20)(21)(22) This procedure has the added advantage of allowing repeated pancreatograms to confirm fistula closure without the need for ERCP. However, the presence of a tube in the nose is less well-tolerated, and hospitalisation is necessary while the drain is in place due to the high-level nursing care required.…”

Section: Diagnosis and Investig Ationsmentioning

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: Diagnosis and Investig Ationsmentioning

confidence: 99%

Section: Diagnosis and Investig Ationsmentioning

confidence: 99%

Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

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“…This conservative medical approach is reported to have achieved a resolution of pancreaticopleural fistula in 31% to 65% of adult cases (4,8,10). Failure of such conservative medical treatment is considered to be an indication for endoscopic or surgical intervention, and there are many reports of patients successfully treated by endoscopic procedures (6,8,(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

et al. 2012

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A 53-year-old man developed bilateral pleural effusion with respiratory failure. The amylase level in the pleural effusion was elevated. He had neither abdominal symptoms nor abdominal physical findings. Abdominal computed tomography (CT) also showed no abnormalities. Magnetic resonance cholangiopancreatography (MRCP) was non-diagnostic, but endoscopic retrograde cholangiopancreatography (ERCP) and subsequent CT showed a fistula connecting the pancreatic duct with the right pleural cavity. The pleural effusion was refractory to drug therapy, leading to the need for surgical intervention. The pathological findings revealed chronic pancreatitis without pseudocysts. The elevated pancreatic amylase in the pleural effusion offered an important clue to the correct diagnosis.

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“…Both these treatments have been used successfully in similar cases. 1,[5][6][7] Stent placement creates a path of low resistance for pancreatic secretions to fl ow into the duodenum by decreasing the intraductal pressure. It also helps to close the fi stula rapidly, not only by abolishing the pancreatic pressure gradient, but also by bridging the site of duct disruption and by mechanically blocking the fi stula lumen.…”

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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Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: a case report

Cited by 33 publications

References 10 publications

Diagnosis and management of pancreaticopleural fistula

Diagnosis and management of pancreaticopleural fistula

Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

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

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