Endoscopic versus surgical treatment for thoracopancreatic fistulas complicating chronic pancreatitis: A systematic review

Koliakos, Nikolaos; Papaconstantinou, Dimitrios; Tzortzis, Andrianos; Renieris, Georgios; Bakopoulos, Anargyros; Schizas, Dimitrios; Zavras, Nick; Pikoulis, Emmanouil

doi:10.1016/j.surg.2021.08.052

Cited by 1 publication

(5 citation statements)

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“…Pancreatitis fluid collections, caused by disruptions of the pancreatic duct, may cross over into the pleural space via the diaphragmatic hiatuses or via subperitoneal lymphatics situated on the left hemidiaphragm. Dyspnea, cough, and chest pain are the most frequent presenting symptoms in such cases [ 2 ]. Pathologic accumulation of fluid within the pleural space can be appreciated in imaging studies, and high concentrations of fluid amylase level can help steer the physician toward the diagnosis of a PF.…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic modality is increasingly expanded. Hence, surgical management is most useful as a salvage procedure [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Noninvasive magnetic resonance cholangiopancreatography (MRCP) is considered a valuable imaging method resulting in an accurate diagnosis in up to 83% of cases [ 3 ]. Nevertheless, it is essential to emphasize the diagnostic and curative potential of endoscopic retrograde cholangiopancreatography (ERCP) regarding pancreatic ductal leaks and fistulas [ 2 ]. In our case, sphincterotomy and pancreatic stent placement eventually led to pancreatic head ductal stone formation, thus increasing pressures in the terminal part of the pancreatic duct, consequently exacerbating drainage outflow volumes from the pancreatic tail and into the thorax.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is recommended when conservative treatment methods fail to improve the patient’s condition and eliminate pancreatic leakage [ 2 ]. Distal pancreatectomy, Roux-en-Y pancreatic duct drainage, and cystojejunostomy have been proposed depending on the location of pancreatic ductal disruption [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic inflammatory diseases causing acinar and ductal cell dysfunction sometimes result in disastrous complications [ 1 ]. Pancreaticopleural fistula (PF) is an extremely rare complication of both acute and chronic pancreatitis as well as pancreatic trauma with duct disruption [ 1 , 2 ]. Pancreatic fluid may enter the pleural cavity either directly through diaphragmatic pores or through the aortic and/or esophageal hiatus, leading to a massive exudative pleural effusion [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Surgical Management of a Pancreaticopleural Fistula After Failed Endoscopic Therapy

Koliakos¹,

Papaconstantinou²,

Reppas³

et al. 2022

Cureus

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Inflammatory diseases of the pancreas or pancreatic trauma result in ductal cell disruption, which in turn may lead to leakage of pancreatic fluid, mostly in the retroperitoneal space. Pancreatopleural fistulas are uncommonly encountered following pancreatic injury; however, they often prove a difficult problem to manage. Herein, we present a rare case of a 68-year-old male suffering from a pancreaticopleural fistula (PF) between the pancreatic tail and the left pleural space one year following splenectomy for trauma. About three months after percutaneous drainage of a left pleural effusion and left upper quadrant abdominal collection and endoscopic pancreatic duct stent placement, surgical management was decided. Distal pancreatectomy and Roux-en-Y drainage of the pancreatic remnant were successfully performed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%