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Acute Pancreatitis with an Ongoing Pancreatic Duct Leak Complicated by Refractory Pleural Effusion: A Case Report

Bashar Khiatah, Thatcher Huynh, Amanda Frugoli, Kip D. Lyche

(Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA)

Am J Case Rep 2021; 22:e931330

DOI: 10.12659/AJCR.931330

BACKGROUND: Acute pancreatitis causes a significant systemic inflammatory response that affects multiple organs. Pulmonary complications include pleural effusions, hypoxia, atelectasis, and acute respiratory distress syndrome. Pleural effusion is an indicator of poor prognosis in pancreatitis. This case report supports the few existing reports about best practice for the diagnosis and treatment of a pancreatic duct leak causing refractory right pleural effusion.
CASE REPORT: In this case report, a woman with long-term rheumatoid arthritis and recent severe gallstone pancreatitis required hospital readmission for progressive shortness of breath from recurrent massive right pleural effusion from the pancreatitis with an ongoing pancreatic leak and a pseudocyst. She had diagnostic thoracentesis and magnetic resonance cholangiopancreatography (MRCP) that was followed by endoscopic retrograde cholangiopancreatography (ERCP) and stent placement as a therapeutic procedure, with complete resolution of her symptoms.
CONCLUSIONS: This case report demonstrates an atypical presentation of complications from severe pancreatitis. MRCP is the criterion standard and best initial test for diagnosing a fistula. When possible, ERCP is preferred for the initial evaluation and treatment of pancreatic leaks and fistulas. In the present case report, treatment with endoscopic cystogastrostomies was effective for the internal drainage of the pseudocyst, pancreatic duct leak, and eventual resolution of the pleural effusion.

Keywords: Digestive System Fistula, Pancreatitis, Pericardial Effusion

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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