Pancreatic-pleural Fistula Research Articles

Pancreatic-pleural fistula as a complication of chronic pancreatitis: a rare case

Pancreatic-pleural fistula as a complication of chronic pancreatitis: a rare case

S1977 Pancreatic Pleural Fistula Presenting as Large Bilateral Pleural Effusions Without Known History of Pancreatitis

S1977 Pancreatic Pleural Fistula Presenting as Large Bilateral Pleural Effusions Without Known History of Pancreatitis

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Milky fluid from where? You are about to find out…

Traumatic chylothorax most commonly occurs after thoracic surgeries with a few cases reported in patients after abdominal surgery. Effusions usually are caused by a pleural reaction during the postoperative period. However, this can also occur from disruption of the thoracic duct during the surgical procedure. The initial approach is conservative with supportive measures, including drainage by ultrasound-guided thoracentesis and diet modification, and surgery is rarely needed. Having a medical history preceding abdominal surgery is always important to consider the possibility of a pancreatic pleural fistula, which can be excluded by an abdominal computed tomography. Lymphangiography is considered the gold standard diagnostic tool, but its use is limited to cases unresponsive to conservative measures. In this patient, a lymphangiography or surgical intervention was not performed since the patient improved after initial management with no recurrent pleural effusion. A new pleural effusion after abdominal surgery must include chylothorax in the differential diagnosis.Keywords: Traumatic chylothorax, hiatal hernia repair, thoracic duct, lymphangiography, abdominal computed tomography

Pancreatic-Pleural Fistula in a Patient With Recurrent Pancreatitis and Unknown Pancreatic Divisum

Recurrent acute pancreatitis (RAP) affects less than 1% of the population and can rarely be associated with severe extra-abdominal complications. We herein present a case of RAP due to a congenital anomaly with a rare thoracic complication that was undiagnosed by classic imaging method to highlight a unique presentation of an uncommon clinical entity.

THE DARKNESS WITHIN: A CASE SERIES OF BLACK PLEURAL EFFUSIONS

TYPE: Case Report TOPIC: Disorders of the Pleura INTRODUCTION: Black pleural effusions are extremely rare with a limited number of etiologies including fungal infections, hemorrhage/hemolysis, and biliopleural/pancreatico-pleural fistulas. This series involves two Caucasian females with differences in their medical history, pathophysiology, and medical outcome. CASE PRESENTATION: Case 1: A 44-year-old female presented with a 3-month history of worsening exertional dyspnea. Past medical history was significant only for pancreatitis 2 years prior. Computed Tomography of the chest showed a large left-sided pleural effusion with complete left lung collapse and a pancreatic pseudocyst. A 14F pigtail chest tube was placed, producing 300mL of black fluid (Figure 1). Laboratory testing indicated amylase levels >6000 U/L. ERCP confirmed pancreatic-pleural fistula. Decortication and washout were performed after discovery of fibrothorax during thorascopic surgery. She was discharged 16 days after admission with re-expansion of the left lung. Case 2: A 36-year-old female presented with abdominal and chest pain in septic shock. Her past medical history was significant for Marfan syndrome, metastatic neuroendocrine tumor with liver metastasis, infective endocarditis, polysubstance abuse, and several abdominal surgeries. Chest CT indicated right-sided pleural effusion and potential esophageal perforation. A 14F chest tube was placed and 200mL of black fluid was drained. Pleural fluid cultures were significant for Enterococcus faecium and Candida glabrata. Despite aggressive management, the patient continued to decompensate and eventually expired. DISCUSSION: These cases highlight differences in presentation and the pathophysiology causing black pleural effusions and adds to the differential. CONCLUSIONS: The black color in these cases is likely due to pleural fluid bilirubin; and hemolysis with infection, respectively. DISCLOSURE: Nothing to declare. KEYWORD: pleural fistula

A rare image of pancreatic-pleural fistula.

A rare image of pancreatic-pleural fistula.

Xanthomatous Pleuritis Associated With Pancreaticopleural Fistula.

Xanthomatous pleuritis is a very rare type of chronic inflammation, with only 3 reports to date.1–3 However, the exact etiology of this disease is unknown. Herein, we present a case of xanthomatous pleuritis that might have been associated with pancreatic pleural effusion. CASE REPORT A 62-year-old male who regularly consumed alcohol (<20 g/day), was a nonsmoker, and had no medical history was referred to our hospital for exertional dyspnea. Laboratory examination revealed leukocytosis (11,200/μL); however, all other findings were normal (C-reactive protein, 0.62 mg/dL; serum amylase, 171 IU/L; serum lipase, 30 IU/L; tumor markers, negative; interferon-gamma release assay, negative). The chest radiograph showed left pleural effusion. Moreover, chest computed tomography (CT) revealed left pleural effusion. We performed thoracoscopy under local anesthesia for drainage and pathologic diagnosis as pleural effusion because of malignancy was considered. Pleural fluid examination revealed bloody exudative (protein, 5.0 g/dL; lactate dehydrogenase, 1264 IU/L; Rivalta reaction, positive; serum total protein, 6.9 g/dL; serum, lactate dehydrogenase 212 IU/L) and high level of amylase (13,355 IU/L). Thoracoscopy of the left thorax revealed diffuse yellow plaque-like deposits in the pleura (Fig. 1). Histology of the left pleural biopsy specimen showed inflammation and foamy cells (Fig. 2). There was no evidence of malignancies and infections, including Mycobacterium. Therefore, we considered the presence of pancreaticopleural fistula and performed further abdominal examinations. An enhanced CT and endoscopic retrograde cholangiopancreatography revealed pancreatic stones, main pancreatic duct dilatation, meandering pancreatic duct, and left pancreaticopleural fistula (Fig. 3). Distal pancreatectomy was performed after thoracic drainage with a chest tube to treat the pancreatic pleural fistula for prevention of pleural effusion recurrence and rule out pancreatic cancer. The surgically resected specimen of the pancreas showed chronic pancreatitis with pancreatic stones and no findings of malignancies. On the basis of these results, xanthomatous pleuritis with pancreaticopleural fistula because of chronic pancreatitis was finally diagnosed. The patient has had an uneventful course without recurrence for more than 4 years.FIGURE 1: A and B, Thoracoscopic image shows diffuse yellow plaque-like deposits in the pleura of the left thorax.FIGURE 2: Biopsy specimen of the pleura with yellow plaque-like deposit shows foamy cells (×400 magnification).FIGURE 3: Endoscopic retrograde cholangiopancreatography reveals meandering pancreatic duct and contrast outflow to the left thoracic cavity (red arrow).DISCUSSION To the best of our knowledge, this is the first report of xanthomatous pleuritis with pancreatic pleural effusion. Xanthomatous pleuritis is a very rare benign type of chronic inflammation, and only 3 cases have been reported in the literature.1–3 Although the exact etiology is uncertain, previous reports2–4 suggested that chronic inflammation, defective lipid transport, and hemorrhage might be the causes of xanthomatous inflammation. In the present case, chronic inflammation because of pancreaticopleural fistula might have caused xanthomatous pleuritis. Furthermore, aberrance of the lipid component of the pancreas might also be a cause of defective lipid transport. In addition, we present the thoracoscopic findings of xanthomatous pleuritis. Thoracoscopy showed diffuse yellow plaque-like deposits in the pleura. This finding was similar to that in a previous report by Bateman et al.3 Xanthoma comprises yellow plaque-like lesions characterized by the presence of lipid-containing histocytes and is commonly found in the gastrointestinal tract.5 The endoscopic finding of xanthoma in the gastrointestinal tract includes yellow spots,6,7 which is very similar to the finding in our case and a previous report.3 Hence, the yellow plaque-like deposits might be the characteristic finding in xanthomatous pleuritis. Physicians should consider the possibility of xanthomatous pleuritis when such thoracoscopy findings are observed. Furthermore, the thoracoscopy finding of xanthomatous pleuritis may indicate the possibility of the presence of pancreatic disease, even though pancreatic disease is not initially considered as a differential diagnosis when physicians examine patients with pleural effusion. Therefore, abdominal examinations, such as abdominal CT, ultrasound, or endoscopic retrograde cholangiopancreatography, should be performed when physicians confirm this thoracoscopy finding. Treatments for xanthomatous pleuritis are yet to be established, although steroids have been used in the previous cases.1,3 Since xanthomatous pleuritis was considered to be associated with pancreaticopleural fistula in the present case, we performed distal pancreatectomy, which led to a favorable outcome. It may be important to find out the underlying causes, such as pancreaticopleural fistula, when physicians diagnose xanthomatous pleuritis. In conclusion, the present case suggests that pancreatic pleural effusion might be a cause of xanthomatous pleuritis, and the thoracoscopic finding of yellow plaque-like deposits in pleura might be the characteristic finding of xanthomatous pleuritis.

An experience of the treatment of a patient with chronic pancreatitis with pancreatic pleural fistula complicated by lung abscesses

Pancreatic pleural fistula is one of the rare and difficulty verifying complication of chronic pancreatitis. We present a rare medical case of a patient with chronic pancreatitis complicated by pancreatic pleural fistula with the formationof multiple lung abscesses. At the same time, the success of the treatment of the patient was due to the staged treatment and the participation of a multidisciplinary team of specialists.

S1549 An Ominous Connection Causing Recurrent Pleural Effusions

Introduction: Fistulation is a rare complication of chronic pancreatitis. Pancreaticopleural fistula (PPF) typically presents with thoracic symptoms. Pathogenesis is related to pancreatic duct obstruction causing leakage of pancreatic fluid, and if persistent can lead to fistula formation. Due to its predominant thoracic over abdominal symptoms, the diagnosis and treatment of PPF are usually delayed. The following case is an example of the potential need for repeat testing to confirm the diagnosis of PPF as well as a multidisciplinary approach to treatment. Case Description/Methods: A 66-year-old white woman presented to the emergency department with 10 days history of worsening dyspnea, orthopnea, and chest tightness. Her medical history was notable for alcohol-induced chronic pancreatitis. On physical examination, she was tachycardic with diminished breath sounds bilaterally. Chest CT angiogram revealed bilateral pleural effusions. Diagnostic right sided thoracentesis revealed exudative fluid pattern, but negative for infection and malignancy. Symptoms initially improved after therapeutic thoracentesis, but pleural effusions shortly recurred requiring repeat thoracenteses. Pleural effusions laboratory findings on thoracenteses are listed in Tables 1 and 2. MRCP showed an irregular tubular tract extending cephalad from the pancreas toward the right diaphragmatic crus and appeared to communicate with the right hydropneumothorax (Figure 1). ERCP was performed which showed diffuse dilatation of the pancreatic duct (Figure 2). Patient underwent therapeutic stenting to the ventral pancreatic duct (Figure 3). She had complete resolution of symptoms and pleural effusions on 2 months follow-up chest CT. Discussion: Pancreatic pleural fistula is a rare complication of chronic pancreatitis and can be a challenging diagnosis as symptoms tend to overlap with other causes of dyspnea, hypoxia and pleural effusions. MRCP is the most sensitive imaging modality, followed by ERCP and CT to visualize pancreatic duct anatomy and guide further therapeutic management. Conservative medical management with bowel rest and somatostatin analog are shown to be effective in patients without pancreatic ductal obstructions. In cases with recurrent pleural effusions despite conservative management, ERCP with therapeutic stenting to alleviate pancreatic ductal obstructions is strongly indicated with high success rate. Owing to its rarity and complexity, a multidisciplinary approach to PPF is warranted to provide the best care possible.Figure 1.: Tables and Figures.

S3476 Workup of a Suspected Pancreaticopleural Fistula in a Young Male

Introduction: Pancreatic fistulas are an abnormal connection between the pancreas and an adjacent or distant structure or organ. These can be characterized as internal or external depending if the pancreatic duct communicates with the skin or not. The most common cause of an internal pancreatic fistula is pancreatitis associated with chronic alcohol. Pancreatopleural fistulas develop by leakage of pancreatic exocrine secretions through the openings in the diaphragm. Here we present a case, where there was concern for a pancreatopleural fistula. Case Description/Methods: A 31-year-old male with past medical history of chronic recurrent pancreatitis complicated by enlarging pseudocysts and portal vein thrombosis was transferred to our facility from outside hospital for hemorrhagic pancreatic pseudoaneurysm status post IR embolization. He had been bleeding from the hemorrhagic pseudoaneurysm at the previous hospital and had been treated with an initial IR embolization procedure for this 4-5 days before arriving at our facility. He underwent repeat IR embolization procedure with repositioning of the malpositioned coil 6 days after admission and subsequently underwent EGD with endoscopic ultrasound and cysgastrectomy for treatment of his associated pancreatic pseudocyst 12 days after admission. Pleural effusion seen on Xray was thought to be secondary to pancreatic fluid accumulation. Thoracentesis was subsequently performed due to patient complaints of dyspnea and analysis showed > 12,000U/L of amylase and black fluid concerning for a pancreatic pleural fistula (Figure A). Patient had a repeat X-ray the following day with accumulation of the pleural effusion (Figure B). Patient was started on TPN and Octreotide for treatment. Repeat thoracentesis yielded amber colored fluid and a CT chest, abdomen and pelvis did not show evidence of fistula formation. It was determined that the initial thoracentesis performed on the patient was actually placed into the pancreatic pseudocyst due to severe elevation of the hemidiaphragm. The patient was ultimately discharged with plans to follow-up with general surgery as an outpatient for possible pancreatectomy. Discussion: We believe that our findings during the care of this patient are important for Gastroenterologists as they provide an excellent opportunity to review both the common and obscure complications of pancreatitis. entity that can occur in patients with acute pancreatitis and is characterized by small, left sided pleural effusions.Figure 1.: Figure A. Thoracentesis fluid obtained from patient concerning for a pancreatic pleural fistula. Figure B. Repeat chest x-ray showing re-accumulation of large left-sided pleural effusion.

ОСОБЕННОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ПАНКРЕАТИКОПЛЕВРАЛЬНЫХ СВИЩЕЙ

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.

Insolit pancreatic-pleural fistula after surgery

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.

1431 A Bad Connection: Chronic Pancreatitis Leading to a Pancreticopleural Fistula

INTRODUCTION: Pancreatic-pleural/mediastinal fistulas are a rare complication of chronic pancreatitis. Fistulous connections occur through fenestrations in the diaphragm. Pancreatic ductal stenting can be valuable, though medical and surgical options may still be required. We describe a case of pancreatic-pleural fistula with mediastinal tracking successfully treated with combined endoscopic and medical management. CASE DESCRIPTION/METHODS: The patient is a 53-year-old male with a history of chronic pancreatitis secondary to alcohol abuse, a pancreatic pseudocyst, and compensated heart failure. The patient was admitted with new onset shortness of breath and epigastric abdominal pain. CT showed acute on chronic pancreatitis with a pseudocyst in the uncinate process, lower mediastinal inflammatory changes, and bilateral pleural effusions. Thoracentesis was performed, demonstrating an amylase of &gt;7500. Though MRCP did not show a discrete connection, the clinical presentation was consistent with pancreatic-pleural fistula. ERCP was performed, but the endoscopist was unable to cannulate the pancreatic duct. Patient was placed on octreotide and continued to undergo therapeutic thoracenteses as needed. Patient returned 1 month later with complaints of neck fullness, continued shortness of breath, and abdominal pain. CT was significant for a fluid collection extending from pancreatic head to the mediastinum tracking along the anterior aspect of the esophagus and persistent pleural effusions. MRCP was performed and revealed a fistulous connection between the pseudocyst, pleural space, and mediastinum. Repeat ERCP was done with successful pancreatic stent placement. Patient subsequently had resolution of both mediastinal and pleural fluid collections. The pancreatic stent was removed with durable resolution of fluid collections. DISCUSSION: Pancreatic fistulas are reported to resolve with supportive care alone in 80% of external and 50-65% of internal fistulas. In our case, supportive care including octreotide use was insufficient for fistula resolution. The patient was ultimately treated successfully with pancreatic stenting. Had this failed, alternative approaches could have included nasojejunal feeding, endoscopic sealants, or surgical correction. This case highlights a rare, but serious complication of chronic pancreatitis and management options to be considered.

PANCREATIC-PLEURAL FISTULA PRESENTING AS RECURRENT UNILATERAL PLEURAL EFFUSION

SESSION TITLE: Critical Care 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pancreatic-pleural fistula (PPF) is a rare complication of pancreatitis. Pleural effusion seen with pancreatitis is usually clinically insignificant but PPF can produce recurrent and large volume pleural effusions. CASE PRESENTATION: A 58-year-old male with a medical history significant for alcohol abuse and recurrent alcoholic pancreatitis presented to our institute with worsening shortness of breath for 2 days.He was recently admitted for the third time to the hospital with similar presentation and was diagnosed with massive left-sided pleural effusion requiring drainage for symptom relief. He started feeling short of breath the very next day after discharge, more on exertion. On admission, his vitals were: HR 118, BP 140/97, RR 22, Temp 98.2F. Physical examination was remarkable for dullness to percussion with reduced air entry up to the left 5th intercostal space.Laboratory workup revealed a serum lipase level of > 600 U/L, serum amylase of 459 U/L mm/hr.Chest x-ray showed opacification of left hemithorax. CT chest confirmed large left-sided pleural effusion with compression collapse of the left lower lung.Pleural fluid analysis showed an exudative effusion with an amylase level of 17675 U/L. MRCP of the abdomen revealed diffusely dilated pancreatic ducts.Despite repeated aspiration, recurrent accumulation of pleural effusion was seen, so a chest tube was inserted.An ERCP was performed for the concern of pancreatic-pleural fistula which was consistent with moderate ductal stenosis and contrast extravasation from the ventral pancreatic duct in the head of the pancreas but did not demonstrate a clearcut fistulous tract. A stent was placed in the stenotic duct. The pleural fluid drainage from the tube decreased markedly, the chest tube was removed next day and a follow-up chest X-ray after 2 weeks revealed no evidence of recurrent pleural effusion. DISCUSSION: Although uncommon, pancreatic-pleural fistula can present with recurrent unilateral clinically significant pleural effusion. Although there is no cutoff level to establish the diagnosis, pleural fluid amylase is usually greater than 1000U/L, with levels of> 50,000U/L highly suggestive of a PPF.ERCP is essential in both the diagnosis and treatment of PPF; it does not only show the site of the leak but also reveals the ductal morphology, it demonstrates the fistulous tract in 59% to 74% of the cases. In our patient, the diagnosis was initially suggested by the very high level of pleuritic fluid amylase level and was confirmed by imaging and ERCP. Treatment was successful after a stent was placed at the site of leakage. CONCLUSIONS: Pancreatic-pleural fistula (PPF) should be included in the differential diagnosis of recurrent and large pleural effusions especially in middle-aged men with a history of alcohol consumption and recurrent pancreatitis. Reference #1: A. R. Dhebri and N. Ferran, “Nonsurgical management of pancreaticopleural fistula,” Journal of the Pancreas, vol. 6, no. 2, pp. 152–161, 2005. Reference #2: R. Materne, P. Vranckx, C. Pauls, E. E. Coche, P. Deprez, and B. E. Van Beers, “Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography,” Chest, vol. 117, no. 3, pp. 912–914, 2000. Reference #3: E. W. Pottmeyer, C. F. Frey, and S. Matsuno, “Pancreaticopleural fistulas,” Archives of Surgery, vol. 122, no. 6, pp. 648–654, 1987. DISCLOSURES: No relevant relationships by Taha Ahmed, source=Web Response No relevant relationships by TALHA AHMED, source=Web Response No relevant relationships by Basma Ricaurte, source=Web Response

Pancreatico‑pleural Fistula: Case Series

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

Pancreatic-pleural fistula: clinical features, diagnosis and treatment

Pancreatic-pleural fistula: clinical features, diagnosis and treatment

Recurrent Right-sided Pleural Effusion Secondary to a Pancreatic-Pleural Fistula: An Endoscopic Solution to a Rare Complication

Recurrent Right-sided Pleural Effusion Secondary to a Pancreatic-Pleural Fistula: An Endoscopic Solution to a Rare Complication

Pleural effusion caused by a pancreatic pleural fistula

Pleural effusion caused by a pancreatic pleural fistula

Pancreatic-pleural fistula in chronic pancreatitis

Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed.We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage.