Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2018; 09(01): 026-031
DOI: 10.4103/jde.JDE_23_17
Case Report

Pancreatico‑pleural Fistula: Case Series

Manoj Munirathinam
1   Institute of Medical Gastroenterology, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
,
Pugazhendhi Thangavelu
1   Institute of Medical Gastroenterology, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
,
Ratnakar Kini
1   Institute of Medical Gastroenterology, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Pancreatico‑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.

Keywords

Endoscopic retrograde cholangiopancreatography - pancreatic pseudocyst - pancreatico‑pleural fistula - pancreatitis - pleural effusion


Publication History

Publication Date:
19 September 2019 (online)

© 2018. Thieme. All rights reserved.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • REFERENCES

  • 1 Rockey DC, Cello JP. Pancreaticopleural fistula. Report of 7 patients and review of the literature. Medicine (Baltimore) 1990; 69: 332-44
    CrossrefPubMedSearch in Google Scholar
  • 2 Broe PJ, Cameron JL. Pancreatic ascites and pancreatic pleural meffusions. In: Bradley EI. editor. Complications of Pancreatitis: Medical and Surgical Management. 1st ed. Philadelphia, PA: WB Saunders; 1982: p. 245
    Search in Google Scholar
  • 3 Gómez-Cerezo J, Barbado Cano A, Suárez I, Soto A, Ríos JJ, Vázquez JJ. et al. Pancreatic ascites: Study of therapeutic options by analysis of case reports and case series between the years 1975 and 2000. Am J Gastroenterol 2003; 98: 568-77
    CrossrefPubMedSearch in Google Scholar
  • 4 Kaman L, Behera A, Singh R, Katariya RN. Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: Recognition and management. ANZ J Surg 2001; 71: 221-5
    CrossrefPubMedSearch in Google Scholar
  • 5 Cameron JL, Kieffer RS, Anderson WJ, Zuidema GD. Internal pancreatic fistulas: Pancreatic ascites and pleural effusions. Ann Surg 1976; 184: 587-93
    CrossrefPubMedSearch in Google Scholar
  • 6 François CJ, Demos TC, Iqbal N. Pancreaticothoracic fistulas: Imaging findings in five patients. Abdom Imaging 2005; 30: 761-7
    CrossrefPubMedSearch in Google Scholar
  • 7 Fulcher AS, Capps GW, Turner MA. Thoracopancreatic fistula: Clinical and imaging findings. J Comput Assist Tomogr 1999; 23: 181-7
    CrossrefPubMedSearch in Google Scholar
  • 8 Ondrejka P, Faller J, Siket F, Tóth G, Sugár I, Forgács B. et al. Isolated massive pleural effusion caused by pancreatico-pleural fistula. Z Gastroenterol 2000; 38: 583-5
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Markos J, Tribe AE, McGonigle P. Recurrent lobar infiltrate and chronic pancreatitis. Med J Aust 1986; 145: 94-6
    CrossrefPubMedSearch in Google Scholar
  • 10 Ridgeway MG, Stabile BE. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am 1996; 76: 1159-73
    CrossrefPubMedSearch in Google Scholar
  • 11 Ondrejka P, Siket F, Sugár I, Faller J. Pancreatic-pleural fistula demonstrated by endoscopic retrograde cholangiopancreatography. Endoscopy 1996; 28: 784
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Dhebri AR, Ferran N. Nonsurgical management of pancreaticopleural fistula. JOP 2005; 6: 152-61
    PubMedSearch in Google Scholar
  • 13 Nordback I, Sand J. The value of the endoscopic pancreatogram in peritoneal or pleural pancreatic fistula. Int Surg 1996; 81: 184-6
    PubMedSearch in Google Scholar
  • 14 Wakefield S, Tutty B, Britton J. Pancreaticopleural fistula: A rare complication of chronic pancreatitis. Postgrad Med J 1996; 72: 115-6
    CrossrefPubMedSearch in Google Scholar
  • 15 Tajima Y, Fukuda K, Tsuneoka N, Tsutsumi R, Kuroki T, Onizuka S. et al. Demonstration of a pancreaticopleural fistula with magnetic resonance cholangiopancreatography. Am J Surg 2004; 187: 741-2
    CrossrefPubMedSearch in Google Scholar
  • 16 Akahane T, Kuriyama S, Matsumoto M, Kikuchi E, Kikukawa M, Yoshiji H. et al. Pancreatic pleural effusion with a pancreaticopleural fistula diagnosed by magnetic resonance cholangiopancreatography and cured by somatostatin analogue treatment. Abdom Imaging 2003; 28: 92-5
    CrossrefPubMedSearch in Google Scholar
  • 17 Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN. Bile duct obstruction and choledocholithiasis: Diagnosis with MR cholangiography. Radiology 1995; 197: 109-15
    CrossrefPubMedSearch in Google Scholar
  • 18 Soto JA, Barish MA, Yucel EK, Siegenberg D, Ferrucci JT, Chuttani R. et al. Magnetic resonance cholangiography: Comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology 1996; 110: 589-97
    CrossrefPubMedSearch in Google Scholar
  • 19 Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomic variants of the biliary tree: Diagnosis with MR cholangiopancreatography. Radiology 1996; 199: 521-7
    CrossrefPubMedSearch in Google Scholar
  • 20 Saeed ZA, Ramirez FC, Hepps KS. Endoscopic stent placement for internal and external pancreatic fistulas. Gastroenterology 1993; 105: 1213-7
    CrossrefPubMedSearch in Google Scholar
  • 21 Neher JR, Brady PG, Pinkas H, Ramos M. Pancreaticopleural fistula in chronic pancreatitis: Resolution with endoscopic therapy. Gastrointest Endosc 2000; 52: 416-8
    CrossrefPubMedSearch in Google Scholar
  • 22 Materne R, Vranckx P, Pauls C, Coche EE, Deprez P, Van Beers BE. et al. Pancreaticopleural fistula: Diagnosis with magnetic resonance pancreatography. Chest 2000; 117: 912-4
    CrossrefPubMedSearch in Google Scholar
  • 23 Shah HK, Shah SR, Maydeo AP, Pramesh CS. Pancreatico-pleural fistula. Endoscopy 1998; 30: 314
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Garcia-Ricart F, Croizet O, El Riwini M, Escourrou J. Endoscopic management of a persistent pancreatopleural fistula. Gastrointest Endosc 1997; 46: 359-61
    CrossrefPubMedSearch in Google Scholar
  • 25 Iglesias JI, Cobb J, Levey J, Rosiello RA. Recurrent left pleural effusion in a 44-year-old woman with a history of alcohol abuse. Chest 1996; 110: 547-9
    CrossrefPubMedSearch in Google Scholar
  • 26 Griesshammer B, Strobel M. Pancreaticopleural fistula treated by transpapillary implantation of a plastic prosthesis. Endoscopy 1998; 30: 741
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Miyachi A, Kikuyama M, Matsubayashi Y, Kageyama F, Sumiyoshi S, Kobayashi Y. et al. Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: A case report. Gastrointest Endosc 2004; 59: 454-7
    CrossrefPubMedSearch in Google Scholar
  • 28 Hastier P, Rouquier P, Buckley M, Simler JM, Dumas R, Delmont JP. et al. Endoscopic treatment of wirsungo-cysto-pleural fistula. Eur J Gastroenterol Hepatol 1998; 10: 527-9
    CrossrefPubMedSearch in Google Scholar
  • 29 Yanagië H, Tani T, Sairennji T, Ogata M, Eriguchi M. A pancreatic pseudocyst with pancreatic pleural effusion: Report of a case. Surg Today 1997; 27: 1064-8
    CrossrefPubMedSearch in Google Scholar
  • 30 Chan KL, Lau WY, Sung JY. Octreotide therapy for pancreaticopleural fistula. J Gastroenterol Hepatol 1994; 9: 530-2
    CrossrefPubMedSearch in Google Scholar