Endoscopic treatment of wirsungo-cysto-pleural fistula

Hastier, P; Rouquier, Patrick; Buckley, Martin; Simler, Jean-Marc; Dumas, R.; Delmont, J

doi:10.1097/00042737-199806000-00017

Cited by 31 publications

(38 citation statements)

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“…(10) ERCP enables the identification of pancreatic duct strictures and stones downstream from the fistula, which can then be treated using pancreatic sphincterotomy, balloon dilatation, stent placement or stone extraction with or without extracorporeal lithotripsy. (20)(21)(22)(23) The aim of stent placement is to achieve decompression of the PD by creating a pathway of least resistance for pancreatic secretions to flow into the duodenum. If possible, the stent should also bridge the site of ductal disruption, thus mechanically blocking the fistula lumen, in order to allow healing.…”

Section: Diagnosis and Investig Ationsmentioning

confidence: 99%

Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

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Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.

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Section: Diagnosis and Investig Ationsmentioning

confidence: 99%

Diagnosis and management of pancreaticopleural fistula

Tay

Chang²

2013

SMedJ

100

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“…In our case, the patient presented with haemorrhagic right-sided pleural effusion which is not common. 3,8 Evaluation for the common aetiologies was unfruitful in our case and diagnosis was made only following the HRCT thorax and CECT abdomen, which suggested a PPF and the presence of high amylase and lipase levels in pleural fluid clinched the diagnosis. MRCP is considered the method of choice for suspected PPF.…”

Section: Final Diagnosismentioning

confidence: 92%

“…While conservative management with inhibition of pancreatic secretion with octreotide may achieve closure of fistula in 31% to 45% of cases, surgery leads to healing in 80% to 90% of cases. [2][3][4][5][6] There are very few documented cases of pancreaticopleural fistula presenting as non-resolving unilateral pleural effusion. 7 PPF presenting as right-sided pleural effusion with intradiaphragmatic fistula rather than fistula through the diaphragmatic hiatus 8,9,10 is rarer still.…”

Section: Final Diagnosismentioning

confidence: 99%

Pancreaticopleural Fistula- A Rare Cause of Haemorrhagic Pleural Effusion

Baruah¹,

Dutta²,

Paul³

et al. 2017

jemds

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HOW TO CITE THIS ARTICLE: PRESENTATION OF CASEA 10-year-old boy presented with complaints of pain abdomen for 8 months, which had increased in severity for 15 days prior to admission along with fever, difficulty in respiration and right-sided dull aching chest pain. On examination, he was pale and tachypnoeic with a normal nutritional status. The trachea was shifted towards left, stony dullness was noted on percussion and breath sounds were decreased on the right side of the chest. Tenderness was present over epigastrium and right hypochondrium. CLINICAL DIAGNOSISClinically, the case was diagnosed as right-sided bacterial pleural effusion with chronic abdominal pain. Further investigations were planned to confirm the diagnosis and to find out the aetiology. DIFFERENTIAL DIAGNOSISDifferential diagnoses can be tubercular pleural effusion or haemorrhagic pleural effusion (rare). Differential diagnoses of pain abdomen can be hepatic abscess, right subphrenic abscess, pancreatic pseudocyst and acute or chronic pancreatitis. So immediate chest x-ray and pleural tapping were planned. PATHOLOGICAL AND RADIOLOGICAL DISCUSSIONRoutine blood examination showed Hb 12.3 gm%, TLC 18,800/mm3 with 87% neutrophils and ESR 30 mm AEFH. Chest X-ray showed total homogenous opacification of the right hemithorax with gross mediastinal shift towards the left. On aspiration, pleural fluid was found to be haemorrhagic. Pleural fluid analysis showed protein 3.8 gm/dL, sugar 40 mg/dL, cell count 580 cells/cumm, mostly lymphocytes and presence of plenty of RBCs. There were no malignant cells. ADA was normal. Culture of pleural fluid showed growth of Acinetobacter baumannii. Tuberculin test was negative. PT, APTT, INR and platelet count were normal. Common causes of haemorrhagic pleural effusion are malignant effusion (most commonly Lymphoma), traumatic effusion, tubercular effusion or bleeding diathesis. The patient was started empirically on Vancomycin, which was changed to Imipenem later as per the sensitivity report.

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“…Seven (17%) patients underwent surgical procedures 11 to 16 mo after endoscopic treatment. Few isolated cases of pancreaticopleural fistula successful treated by endoscopic drainage, have been reported [68] . Trans-papillary drainage is also reported as a successful treatment for pancreaticoperitoneal fistulas.…”

Section: Endoscopic Treatment Of Pancreatic Fistulasmentioning

confidence: 99%

Endoscopic treatment of chronic pancreatitis

Heyries¹,

Sahel²

2007

WJG

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Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, n e w i m p r o v e m e n t s w e r e n e c e s s a r y : f a i l u r e s o f pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated. METHODSEndoscopic treatment needs a team (operator, anaesthesiologist) aware with Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Specific material is necessary: good fluoroscopy with the possibility to magnify pictures, and a duodenoscope with a 4.2 channel allowing insertion of high calibre stent (10 Fr). Moreover, a wide variety of endoscopic ancillar y instruments is essential: metallic and hydrophilic guidewire, sphincterotomes, Dormia basket, balloon dilatators and bougie dilatators (5-11.5 Fr), but also very thin guide wire (0.025 inches), fine-tipped sphincterotomes, Soehendra extractors (cf infra) [1] . Impaction of stones in pancreatic ducts needs the use of extracorporeal shock wave lithotripsy before endoscopic stone extraction [2]

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Endoscopic treatment of wirsungo-cysto-pleural fistula

Cited by 31 publications

References 0 publications

Diagnosis and management of pancreaticopleural fistula

Diagnosis and management of pancreaticopleural fistula

Pancreaticopleural Fistula- A Rare Cause of Haemorrhagic Pleural Effusion

Endoscopic treatment of chronic pancreatitis

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