Insolit pancreatic-pleural fistula after surgery

Abstract

Background: Pleural effusion secondary to pancreatic-pleural fistula (PPF) is a rare entity. Its main cause is acute or chronic pancreatitis and its diagnosis is difficult and can be confirmed by toracocentesis. Our aim is to show the case of a patient who presented a recurrent pleural effusion due to a PPF after surgery. Material & Methods: A 26-year-old male with no relevant medical history was diagnosed of malignant mesenchymal neoplasia located in the upper pole of the left kidney measuring approximately 9.5x 8.7x1.6cm. The patient underwent resection of the left kidney and suprarenal, spleen, body and tail of the pancreas, left tail and diaphragmatic patch. He presented initial postoperative without incidents until the sixth day when he began with respiratory distress and abdominal distension. A CT scan was performed reporting a severe left pleural effusion. Thoracic drainage showed high amylase compatible with pancreatic fistula in liquid. Results: According to the literature, the initial treatment in our patient was non-operative using total parenteral nutrition and thoracic drainage. We started an anti-secretory octreotide and antibiotic therapy. The evolution was satisfactory, so we decide not to manage endoscopically with ERCP to place of a stent as we could see in cases of PPF due to pancreatitis. The patient presented a satisfactory evolution and he was discharged at home 4 days after complete resolution of pleural effusion. The definitive AP was high-grade undifferentiated pleomorphic sarcoma. Follow-up at 7 months showed the patient is well. Conclusions: PPF is an uncommon complication, which has been described in the majority of cases in patients with pancreatitis. We want to point out the importance of surgery as a risk factor in this entity so we should consider this diagnosis in patients with thoracic complaints and a history of earlier pancreatic surgery.