Octreotide

Abstract

Treatment failure: case reportA 9-year-old boy exhibited treatment failure while being treated with octreotide for pancreaticopleural fistula (PPF) and right pleural effusion.The boy was admitted due to massive right pleural effusion secondary to PPF, a complication of chronic pancreatitis (CP). Subsequently, he was started on conservative management with IV octreotide infusion at up to 1 µg/kg/hour, along with parenteral nutrition and hydration. His abdominal pain and dyspnoea improved. Also, his right pleural effusion decreased. Thereafter, his octreotide therapy was tapered, and then discontinued after 3 days. He was then discharged to home with antioxidants (selenium, retinol [vitamin A], ascorbic acid [vitamin C] and vitamin E). However, 1 week after discharge, the symptoms reoccurred with a large right pleural effusion and enlarged PPF. Thus, bowel rest, continuous IV octreotide infusion, along with total parenteral nutrition were again used to treat PPF and pleural effusion; however, he had persistent gastrointestinal and respiratory symptoms. Thereafter, he was successfully managed by endoscopic pancreatic duct stent placement after failure of conservative treatment (octreotide) approache. He was then discharged 1 week later.