Abstract
Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.
Highlights
Pancreaticopleural fistula (PPF) is one of the rarest complications of acute and chronic pancreatitis
Leakage of secretions from the pancreas or ruptured pancreatic pseudocyst may be fistulated into the thorax directly through the diaphragm or through the aortic and oesophageal diaphragmatic hiatuses
We present a case of PPF in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions
Summary
Pancreaticopleural fistula (PPF) is one of the rarest complications of acute and chronic pancreatitis. It is characterised by the presence of amylase-rich pleural fluid resulting from an established fistulous communication between the pancreas and/or pancreatic pseudocyst and the pleural cavity [1, 2]. The diagnosis is often delayed and many patients undergo extensive pulmonary investigations before the final diagnosis is reached. For this reason, PPF must be suspected in individuals with recurrent pulmonary effusions and concomitant history of pancreatitis. We present a case of PPF in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions
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