ОСОБЕННОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ПАНКРЕАТИКОПЛЕВРАЛЬНЫХ СВИЩЕЙ

Abstract

The analysis of features of diagnosis and treatment of pancreaticopleural fistulas according to the materials of publications and own clinical observation of a 44-year-old patient with fistula between a false pancreas cyst and both pleural cavities is presented. Diagnosis in the debut of this disease was complicated by the prevalence of pleural pulmonary pathology, lack of characteristic clinical signs of pancreatic lesion and lack of references to them in the anamnesis. The sudden color change of pleural exudates from straw yellow to red-brown and comparison of the results of blood serum and pleural fluid analysis for amylase content allowed suspecting pancreatogenic origin of bilateral hydrothorax, which served as a basis for instrumental examination of the pancreas. The nature and prevalence of the process in the pancreas, abdominal cavity and the presence of pancreaticopleural fistula with bilateral hydrothorax were established by ultrasound and multispiral computer tomography of the thoracic and abdominal cavities; specification - by magnetic resonance imaging in the modes of T1-BI, T2-BI and magnetic resonance cholangiopancreatography(MRCP). Conservative treatment of acute inflammation of the pancreas in combination with puncture method of sanation of pleural cavities led to the elimination of pancreatic pleural fistula and bilateral hydrothorax. The choice of the method for the rehabilitation of pleural cavities should be justified by the nature, volume, rate of exudates accumulation and its infection. Magnetic resonance cholangiopancreatography (MRCP) is being used routinely to determine the expediency, possibility and the choice of method and volume of surgical treatment of pancreas pathology.