DOI: https://dx.doi.org/10.18203/2349-3933.ijam20221849
Published: 2022-07-25

A rare case of pancreato-pleural fistula with left sided massive pleural effusion

Priyadharshini V., Sanjay Surya G. S., Gowri A. Shankar, Sachin K. Dhande, Anbalagan Pichaimuthu

Abstract


Pancreaticopleural fistula is a very rare complication of acute and chronic pancreatitis. High index of suspicion is needed to diagnose in patients with alcohol induced pancreatitis, presenting with recurrent or persistent pleural effusion. Patient typically presented with pulmonary symptoms, rather than abdominal complaints, leading to delay in the diagnosis. Here we present a case of a known chronic pancreatitis who presented to us with massive left sided pleural effusion. Blood coloured pleural fluid analysis showed lipase and amylase levels in hundred thousand and ten thousand ranges. Diagnosis was made by CECT abdomen and confirmed with MRCP. Patient was treated with first line medical management of thoracocentesis and ERCP with pancreatic duct stenting.


Keywords


Pancreaticopleural fistula, Pleural effusion, Pancreatitis

Full Text:

PDF

References


Rockey DC, Cello JP. Pancreaticopleural fistula. Report of 7 patients and review of the literature. Medicine. 1990;69(6):332-44.

Yeon CJ. Shackelford's surgery of the alimentary tract. United State of America: Saunders; 2012.

Dhebri AR, Ferran N. Nonsurgical management of pancreaticopleural fistula. JOP. 2005;6(2):152-61.

Francisco E, Mendes M, Vale S, Ferreira J. Pancreaticopleural fistula: an unusual complication of pancreatitis. BMJ Case Rep. 2019;22:41-8.

Mihai C, Floria M, Vulpoi R, Nichita L, Cijevschi PC. Pancreatico-pleural fistula - from diagnosis to management. A case report. J Gastrointestin Liver Dis. 2018;27:465-9.

Burgess NA, Moore HE, Williams JO, Lewis MH. A review of pancreatico-pleural fistula in pancreatitis and its management. HPB Surg. 1991;5:79-86.

Sut R, Ramachandran GM, Diamond T. Pancreaticopleural fistula: a rare complication of ERCP-induced pancreatitis. Ulster Med J. 2009;78(3): 185-6.

Cameron JL, Kieffer RS, Anderson WJ, Zuidema GD. Internal pancreatic fistulas: pancreatic ascites and pleural effusions. Ann Surg. 1976;184(5):587-93.

Sasturkar SV, Gupta S, Thapar S, Shasthry SM. Endoscopic management of pleural effusion caused by a pancreatic pleural fistula. J Postgraduate Med. 2020;66(4):206-8.

Wakefield S, Tutty B, Britton J. Pancreaticopleural fistula: a rare complication of chronic pancreatitis. Postgrad Med J. 1996;72(884):115-6.

Francois CJ, Demos TC, Iqbal N. Pancreaticothoracic fistulas: imaging findings in five patients. Abdomen Imaging. 2005;30(6):761-7.

Tay CM, Chang SK. Diagnosis and management of pancreaticopleural fistula. Singapore Med J. 2013; 54(4):190-4.

Singh S, Yakubov M, Arya M. The unusual case of dyspnea: a pancreaticopleural fistula. Clin Case Rep. 2018;6(6):1020-2.

Vyas S, Gogoi D, Sinha SK, Singh P, Yadav TD, Khandelwal N. Pancreaticopleural fistula: an unusual complication of pancreatitis diagnosed with magnetic resonance cholangiopancreatography. J Pancreas. 2009;10:671-3.

Chan EE, Shelat VG. Pancreaticopleural fistula causing massive right hydrothorax and respiratory failure. Case Rep Surg. 2016;8:294-6.

Safadi BY, Marks JM. Pancreatic-pleural fistula: the role of ERCP in diagnosis and treatment. Gastrointestinal Endoscop. 2000;51(2):213-5.