Korean J Hepatobiliary Pancreat Surg.  2006 Dec;10(4):29-33.

Pancreaticopleural Fistula : Complication of Chronic Pancreatitis

• Park SY
• Jang JY
• Lee SE
• Yang SH
• Kim SW

Abstract

A 64 year-old male, with a history of alcoholism, presented at our hospital with dyspnea. He had a history of admission to hospital for treatment of chronic pancreatitis 4 month ago. Chest radiography showed a marked amount of right pleural effusion. Thoracentesis revealed an exudate of amylase-rich fluid. After conservative management he was discharged, but 1 month later increased right pleural effusion was detected. A pancreaticopleural fistula was detected on ERCP and abdomen CT. After 2 months of conservative management, there had been no improvement of the fistula; therefore, the authors decided to operate. The pancreas was hard and atrophic, with severe adhesion to adjacent tissues. Several pancreatic duct stones were found intraoperatively, with a pseudocyst was also found at the body portion. A suspicious fistula tract was observed at the posterior aspect of the body, which was subsequently ligated. A distal pancreatectomy, with a lateral pancreaticojejunostomy, and an additional side-to-side choledochojejunostomy were performed. A small amount of right pleural effusion was detected, with thoracentesis performed on the 8th postoperative day. The pleural effusion did not show a pancreatic juice nature, with amylase and protein levels of 9 U/L and 2,127 mg/L, respectively. No further increase in the amount of pleural effusion was observed, and the patient was discharged on the 16th postoperative day, without any complications. There was no evidence of recurrence at the 6 month follow up.

Keyword

Pancreatic fistula; Pleural effusion; Chronic pancreatitis

MeSH Terms

Abdomen
Alcoholism
Amylases
Cholangiopancreatography, Endoscopic Retrograde
Choledochostomy
Dyspnea
Exudates and Transudates
Fistula*
Follow-Up Studies
Humans
Male
Middle Aged
Pancreas
Pancreatectomy
Pancreatic Ducts
Pancreatic Fistula
Pancreatic Juice
Pancreaticojejunostomy
Pancreatitis, Chronic*
Pleural Effusion
Radiography
Recurrence
Thorax
Amylases