Pancreatic–pleural fistula is best managed by early operative intervention

A Case of Pancreaticopleural Fistula Successfully Treated with a Pancreatic Duct Stent

“…Despite the growing number of cases of PPF treated in endoscopy, multiple questions about the technique stay unanswered. One of these questions is what should be the duration of stenting to alleviate the fistula [7][8][9][10]. The burden of PPF cases report like this one could give clues to these questions.…”

“…Previous case series suggest a success rate between 30 and 65% for medical treatment alone [1,2,[5][6][7]. Observational data suggest that medical treatment alone is associated with longer hospitalisation time and more complications because of the low rate of spontaneous resolution of the fistula [1,7,8]. Actually, the key point for treatment of PPF is based on the pancreas duct anatomy of the patient, especially on the identification of duct stricture and site of duct disruption [2,5,9].…”

Spontaneous Rupture of Pseudopancreatic Cyst Causing Massive Pleural Effusion

“…The enzyme-rich pleural fluid is due to disruption of the dorsal pancreatic ductal system (Traverso & Kozarek, 1999).Typically, the patients are middle-aged males(40-50 years) with chronic pancreatitis related mainly to alcohol abuse. As reported by Ali et al (2009) and King et al (2010), due to predominant pulmonary symptoms in form of cough and dyspnoea, the diagnosis is often delayed and the patients are usually worked up extensively for pulmonary pathology.Chest X-ray is the first line of investigation but it only gives information of pleural effusion. However majority of the cases give past history of recurrent attacks of pancreatitis and pleural fluid aspirate is characteristically haemorrhagic in appearance with very high amylase level.A CT scan of the chest and abdomen confirms the diagnosis.…”

“…Regarding treatment of such cases, Ali et al (2009) and King et al (2010) suggested that in acute cases presenting with respiratory distress due to massive pleural effusion, urgent thoracocentasis/tube thoracostomy should be done. It helps in relief of symptoms and encourages apposition of serosal surfaces.…”

“…Massive pleural effusion associated with pancreaticopleural fistula is a rare complication and it should be suspected on the basis of clinical picture and analysis of pleural fluid following thoracocentesis which reveals an extremely elevated pleural fluid amylase level (King et al, 2010). We are reporting one such case that presented with acute onset dyspnoea.…”