Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)
Marco Antonio Bustamante Bernal, Jose Lisandro Gonzalez Martinez, Arleen Ortiz, Marc J. Zuckerman
Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
Am J Case Rep 2017; 18:750-753
Pancreatic-pleural fistula (PPF) is an uncommon complication of pancreatitis. Pleural effusions secondary to PPF are caused by fistulization of pancreatic secretions to the thorax derived from the rupture or leakage of a pseudocyst.
CASE REPORT: We describe the case of a 44-year-old male with recurrent right-sided pleural effusions and alcoholic pancreatitis who presented with epigastric pain and shortness of breath. Pleural fluid analysis revealed an amylase of 7002 U/lt. MRCP showed segmental narrowing and stricture of the proximal main pancreatic duct and an area of walled-off necrosis. The fistula was managed endoscopically with ERCP and placement of a plastic stent into the pancreatic duct. The pleural effusion resolved and subsequent examinations showed no evidence of recurrence.
CONCLUSIONS: The diagnosis of PPF is challenging. Endoscopic treatment of PPF can be a safe and effective approach.
Keywords: Pancreatic Fistula, Pancreatitis, Pleural Effusion