Pancreatic pseudocyst extending into mediastinum and causing complete dysphagia

Rationale: Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms. Patient concerns: A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission. Diagnosis: Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid. Interventions: Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed. Outcomes: The surgery led to recovery. Six months later, the patient reported good health and weight gain. Lessons: Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.

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“…[19,20] In some cases of less complicated pancreatic fistulas, endoscopic or laparoscopic internal drainage is also effective and safe. [8,9,20]…”

Section: Discussionmentioning

confidence: 99%

“…[6] Dysphagia rarely occurs as the presenting symptom and is more common in mediastinal fistulas. [7,8]…”

Section: Introductionmentioning

confidence: 99%

Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom

2019

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Pancreatic pseudocyst extending into mediastinum and causing complete dysphagia

Cited by 1 publication

References 4 publications

Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom

Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom

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