Summary
Background: Massive pleural
effusions are uncommon but well-documented complications of chronic
pancreatitis, usually caused by the development of a pancreaticopleural
fistula. The mechanism of the fistula formation is thought to be rupture of the
pancreatic duct or pseudocyst.
Material and methods: In the past 7 years we
have treated 5 patients with massive pleural effusion of pancreatic origin in
the Surgical Department of Semmelweis University Medical School. 4 patients
were males; the average age was 52 years (range: 46-59 years).
Results: All 5 patients had a history of
alcohol abuse and were admitted to the pulmonary department because of
respiratory distress. Other symptoms such as abdominal pain, chest pain, or
weight loss were not always present. The diagnosis was confirmed by a markedly
elevated amylase level in the aspirated pleural fluid. Abdominal ultrasound, CT
scan, and ERCP examinations were carried out in order to determine the cause of
the pancreaticopleural fistula. Conservative (nonsurgical) treatment was
effective within 3 weeks in only one case. The other 4 patients required
surgical management. In 3 cases distal pancreatic resection with
splenectomy and cholecystectomy was done. In one case cystojejunostomy was
performed. All 5 patients have been cured with complete resolution of their
pleural effusions.
Conclusions: Patients with large pleural
effusions may have underlying pancreatitis with a pancreaticopleural fistula.
It is important to establish this diagnosis because treatment may require
operative interventions.
(Durch eine pankreato-pleurale Fistel verursachter isolierter
massiver Pleuraerguss)
Hintergrund: Der massive Pleuraerguss ist
eine seltene, aber bekannte Komplikation der chronischen Pankreatitis,
verursacht durch pankreatikopleurale Fisteln. Ursächlich liegt eine Ruptur
des Pankreasganges oder einer Pseudozyste zugrunde.
Material und Methode: Fünf Patienten
(männlich = 4, weiblich = 1)
wurden in den letzten 5 Jahren wegen massiven Pleuraergusses in der
Chirurgischen Klinik der Semmelweis-Universität für Medizinische
Wissenschaften behandelt.
Ergebnisse: Alle 5 Patienten, welche
sämtlich einen Alkoholabusus betrieben, wurden wegen respiratorischer
Insuffizienz in die Pulmonologische Abteilung aufgenommen. Andere
Symptome, wie abdominale oder thorakale Schmerzen und Gewichtsverlust, waren
nicht in allen Fällen vorhanden. Die Diagnose wurde anhand einer
erhöhten Amylaseaktivität im Pleuraerguss bestätigt. Abdominale
Ultraschall-, CT- und ERCP-Untersuchungen wurden durchgeführt, um die
Ursache der pankreatikopleuralen Fistel festzustellen. Die konservative
Behandlung war innerhalb von 3 Wochen nur bei einem Patienten effektiv. Die
anderen 4 Patienten wurden operiert. Bei 3 Patienten wurde eine distale
Pankreasresektion mit Splenektomie und Cholezystektomie durchgeführt,
bei einem Patienten eine Zystojejunostomie. Bei allen 5 Patienten bildete sich
der Pleuraerguss vollständig zurück.
Schlussfolgerungen: In Fällen von
isoliertem Pleuraerguss muss an einen pankreatogenen Ursprung gedacht werden.
Zur Heilung dieser Patienten kann die operative Behandlung notwendig sein.
Key words
Pancreatico-pleural Fistula - Pleural Effusion - Chronic Pancreatitis
Schlüsselwörter
Pankreatopleurale Fistel - Pleuraerguss - chronische Pankreatitis
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Address for correspondence:
P. Ondrejka, MD, PhD
2nd Department of Surgery Semmelweis University
Faculty of Medicine Budapest, XII.
Kútvölgyi út 4
Hungary, H-1125
eMail: onpal@kut.sote.hu
