Pleuropancreatic Fistulae: Specialist Center Management

Khan, Asaad; Ching, Ricardo Montoya; Morris‐Stiff, Gareth; England, Ruth; Sherridan, M. B.; Smith, Andrew M.

doi:10.1007/s11605-008-0699-0

Cited by 15 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ERCP with pancreatic stent placement results in resolution of PPF in majority of the cases. 4 In our patient, ERCP was not possible because of the duodenal stenosis. Surgery is used if stent placement and/or medical therapy fails and usually includes distal pancreatectomy or pancreatojejunostomy.…”

Section: Discussionmentioning

confidence: 68%

Frey Procedure for Pancreaticopleural Fistula

Cocieru

Saldinger

2010

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

A 59-year-old woman with alcoholic chronic pancreatitis and multiple readmissions for exacerbation developed acute shortness of breath. Chest X-ray showed massive rightsided pleural effusion, and a thoracocentisis revealed amylase content of 12,000 U/L. Magnetic resonance cholangiopancreatography (MRCP) suggested presence of the pancreatic pseudocyst in the porta hepatitis with possible pancreaticopleural fistula (PPF). Pleural effusion recurred soon after thoracocentesis despite treatment with total parenteral nutrition (TPN) and somatostatin. An endoscopic retrograde cholangiopancreatography (ERCP) was not possible secondary to duodenal stenosis caused by the inflammatory pancreatic head mass. The patient underwent an exploratory laparatomy during which a direct pancreatic ductogram demonstrated the PPF tract (Figs. 1 and 2). Fistula was outlined by the methylene blue injection into the main pancreatic duct. A Frey procedure (pancreatic head local resection and pancreatojejunostomy), to provide decompression of the pancreatic duct, as well a gastrojejunostomy and feeding jejunostomy were performed. Postoperative course was complicated by bleeding from pancreatic branches of the splenic artery, requiring embolization per interventional radiology. There was no recurrence of PPF on subsequent 3 years follow-up. DiscussionPPF is the rare complication of pancreatitis, with the incidence of 0.4-4.5%. 1-3 Only 63 cases have been reported so far in the English literature. Majority of patients are alcoholics with chronic pancreatitis in which PPF develops as the sequela of the incompletely formed/ ruptured pancreatic pseudocyst or direct pancreatic duct leak. Most common presenting symptom is shortness of breath due to the pleural effusion. Thoracocentesis reveals elevated amylase content. PPF could be demonstrated by ERCP, MRCP, or CT with sensitivity 78%, 80%, and 47%, respectively. 2 Medical therapy with TPN and somatostatin is effective in only 30-60% of the cases. ERCP with pancreatic stent placement results in resolution of PPF in majority of the cases. 4 In our patient, ERCP was not possible because of the duodenal stenosis. Surgery is used Figure 1 Intraoperative photo showing cored pancreatic head and longitudinal opening of the pancreatic duct. PPFC indicates catheter in pancreaticopleural fistula, PDC-catheter in main pancreatic duct.

show abstract

Section: Discussionmentioning

confidence: 68%

Frey Procedure for Pancreaticopleural Fistula

Cocieru

Saldinger

2010

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

show abstract

“…Some reports have shown that the diagnostic sensitivity of MRCP is almost the same as that of ERCP and is higher than that of CT [21][22][23] . Our previous report found that a precise assessment of the pancreatic ductal system is essential for effectively managing patients with IPF; MRCP can be a promising tool for evaluating the pancreatic duct system, and it is also helpful for selecting the optimal treatment strategy 24) .…”

Section: Discussionmentioning

confidence: 95%

Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system

Tanaka¹,

Kuroki²,

Kitasato³

et al. 2013

Pancreatology

View full text Add to dashboard Cite

Abstract[Background]Internal pancreatic fistula (IPF) is a well-recognized complication of pancreatic diseases. Although there have been many reports concerning IPF, the therapy for IPF still remains controversial. We herein report our experiences with endoscopic transpapillary pancreatic stent therapy for IPF and evaluate its validity.[Method]Six patients with IPF who presented at our department and received endoscopic transpapillary pancreatic stent therapy were investigated, focusing on the clinical and imaging features as well as treatment strategies, the response to therapy and the outcome.[Results]All patients were complicated with stenosis or obstruction of the main pancreatic duct, and in these cases the pancreatic ductal disruption developed distal to the areas of pancreatic stricture. The sites of pancreatic ductal disruption were the pancreatic body in five patients and the pancreatic tail in one patient. All patients received endoscopic stent placement over the stenosis site of the pancreatic duct, and three patients improved completely and one patient improved temporarily. Finally, three patients underwent [Conclusion]Endoscopic transpapillary pancreatic stent therapy may be an appropriate first-line treatment to be considered before surgical treatment. The point of stenting for IPF is to place a stent over the stenosis site of the pancreatic duct to reduce the pancreatic ductal pressure and the pseudocyst's pressure.

show abstract

“…Strictures are treated by dilatation, followed by stenting with plastic stents or a fully covered self‐expanding metal stent . The success rate of ERCP in treating ductal disruptions and pancreatic effusions is between 55% and 100% …”

Section: Discussionmentioning

confidence: 99%