Pancreaticopleural Fistula: A Rare Presentation and a Rare Complication

Ramahi, Ahmad; Aburayyan, Kanana; Ahmed, Tamer Said; Vyas, Rohit; Taleb, Mohammad

doi:10.7759/cureus.4984

Cited by 13 publications

(28 citation statements)

References 9 publications

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“…ERCP with sphincterotomy and pancreatic duct stent placement mechanically blocks the connecting track from the pancreatic duct and forces the pancreatic duct open so that the secretions can drain to the duodenum instead of the pleura or pericardium. 3 If spontaneous fistula resolution is achieved with follow-up imaging, as demonstrated in our patient, an invasive surgery could be avoided. Surgical treatment is warranted if patients demonstrate persistent fistulas or worsening pancreatic collections at follow-up.…”

Section: Discussionmentioning

confidence: 66%

Endoscopic Management as a Viable Therapy for Pancreaticopleural and Pancreaticopericardial Fistulas

Chan¹,

Petersile²,

Churrango³

et al. 2021

ACG Case Rep J

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Pancreatic fistulas are rare complications of chronic pancreatitis, typically caused when disruption of the pancreatic duct causes leakage of pancreatic fluid that erodes through neighboring organs and structures. Pancreatic fistulas to the pericardium and pleural spaces are extremely rare, and cases of multiple fistulas tracking from the pancreas have not been reported before. Management of these fluid collections is challenging with no consensus described in the current literature. We report a case of a patient with concurrent pancreaticopericardial and pancreaticopleural fistulas who improved with endoscopic management.

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Section: Discussionmentioning

confidence: 66%

Endoscopic Management as a Viable Therapy for Pancreaticopleural and Pancreaticopericardial Fistulas

Chan¹,

Petersile²,

Churrango³

et al. 2021

ACG Case Rep J

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“…Placement of an ERCP stent is a new nonsurgical treatment for PPF. An ERCP stent can open the proximal end of the pancreatic duct, smoothly drain the pancreatic juice, allow the pancreatic juice to flow to the duodenum with low resistance, and close the fistula that is abnormally connecting the pancreatic duct and pleura[ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography in the treatment of pancreaticopleural fistula in children

Zhang

Gao

Guo

et al. 2020

WJG

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BACKGROUND Pancreaticopleural fistula (PPF) is a rare disease, especially in children. Conservative treatment and surgery are traditional therapies, but surgery is invasive. The emergence of endoscopic retrograde cholangiopancreatography (ERCP) has provided a new noninvasive treatment for PPF and may become the first choice for children with PPF. AIM To explore the treatment response to ERCP for PPF in children. METHODS Seven children with PPF were hospitalized in the Gastroenterology Department of Beijing Children’s Hospital from December 2007 to May 2019. Data on these seven patients’ clinical characteristics, diagnosis, treatments, and outcomes were analyzed, and their treatment responses following surgery and ERCP were compared. The correlation between the length of hospital stay and conservative treatment was analyzed. Peer-reviewed articles written in English and Chinese published from January 2009 to December 2019 were obtained from various open data sources and reviewed. RESULTS The seven patients comprised three boys and four girls with a mean age of 6.57 ± 3.26 years. The main symptoms were chest tightness and pain ( n = 4), intermittent fever ( n = 3), dyspnea ( n = 3), and abdominal pain ( n = 1), and all patients had bloody pleural effusion. All seven patients were diagnosed with PPF by magnetic resonance cholangiopancreatography, and all were initially treated conservatively for a mean of 34.67 ± 22.03 d with a poor response. Among five patients who underwent ERCP, one required surgery because of intubation failure; thus, the success rate of ERCP was 80%. Two patients were successfully treated with surgery (100%). The postoperative hospital stay of the two patients treated by surgery was 20 and 30 d, respectively (mean of 25 d), and that of the four patients treated by ERCP ranged from 12 to 30 d (mean of 19.25 ± 8.85 d). The recovery time after ERCP was short [time to oral feeding, 4-6 d (mean, 5.33 ± 1.15 d); duration of closed thoracic drainage, 2-22 d (mean, 13.3 d)]. Analysis of previous cases of PPF published worldwide during the past decade showed that the treatment success rate of ERCP is not lower than that of surgery. There was no significant difference in the postoperative hospital stay between surgery (16 ± 10.95 d) and ERCP (18.7 ± 6.88 d, P > 0.05). A positive linear correlation was found between the overall hospital stay and ERCP intervention time ( R 2 = 0.9992). CONCLUSION ERCP is recommended as the first-choice treatment for PPF in children. ERCP should be performed as early as possible if conditions permit.

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“…Chronic pancreatitis causing PPF is accelerated unchangeable in lammatory activity portrayed by substitution of normal pancreatic parenchyma with ibrotic connective-tissue after repetitive attacks of in lammation leading to extravasation of in lammatory luid forming granulated istulous tract between pancreas and Pleural-cavity (Ali et al, 2009;Aswani and Hira, 2015). A posterior distortion of PD or posterior pseudo-pancreatic cyst blowout into retro-peritoneum results into the pancreatic section to ascend to pleural space through natural ori ices like aortic or hiatus or directly through diaphragm on either side, rarely if distortion is anterior resultant is Pancreatico-peritoneal istula giving rise to ascites (Ramahi et al, 2019;Lee et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Incidence of less than 0.4% of pleural effusion due to CP. The total number of cases reported till 2017 of PPF worldwide is 40 (Rao and Raghavendra, 2015;Ramahi et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Most PPF's are formed by the leak of pancreatic secretion from posterior distortion of PD or posterior rupture of pancreatic pseudocyst. Once the diagnosis is con irmed, treatment is usually directed to obliterate istula between the pancreas and pleural cavity conservatively, endoscopically or surgically (Ramahi et al, 2019;Tay and Chang, 2013).…”

Section: Introductionmentioning

confidence: 99%

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A rare case of pancreaticopleural fistula patient presented in surgery OPD

Dighe¹,

Shinde²,

Shinde³

et al. 2020

ijrps

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Pancreatico-pleural fistula is rare and infrequent complication of commonly occurring chronic pancreatitis leading to an extra-peritoneal abnormal connection between the pancreatic system and pleural cavity. Diagnosis needs high-level clinical suspicion to avoid delay in the diagnosis as the patient presents with respiratory distress rather than any abdominal symptom and produces large quantities of pleural fluid intractable of pleural tapping or chest drain. Diagnosis of the fistula is clicked by elevated pleural fluid amylase. Various imaging options are available with their unique importance like CECT, ERCP and MRCP. In a low resource, setup CECT becomes a useful modality to delineate the pancreatic parenchymal changes, pancreatic duct anatomy and fluid collection, thus aid in the diagnosis. Treatment modalities depending on structural anatomy of the duct and parenchymal destruction are either Medical, Conservative and Surgical. Here our patient presented with massive left sided pleural effusion resistant to surgical intervention secondary to chronic pancreatitis in a 28-year man later diagnosed as Pancreatico-pleural fistula on CECT. The patient underwent distal pancreatectomy with splenectomy with decortication of the lung with excision of PPF. The patient now is continuous follow-up for chronic pancreatitis and is symptom-free from last 2 years.

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Pancreaticopleural Fistula: A Rare Presentation and a Rare Complication

Cited by 13 publications

References 9 publications

Endoscopic Management as a Viable Therapy for Pancreaticopleural and Pancreaticopericardial Fistulas

Endoscopic Management as a Viable Therapy for Pancreaticopleural and Pancreaticopericardial Fistulas

Endoscopic retrograde cholangiopancreatography in the treatment of pancreaticopleural fistula in children

A rare case of pancreaticopleural fistula patient presented in surgery OPD

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