J Korean Surg Soc.  2009 Mar;76(3):187-191. 10.4174/jkss.2009.76.3.187.

Pancreaticopleural Fistula with Hemothorax

• Sul YH
• Shin HS
• Lee KH
• Chun KS
• Song IS

• KMID: 2096542
• DOI: http://doi.org/10.4174/jkss.2009.76.3.187

Abstract

Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. We report a case of pancreaticopleural fistula that was presented with right-sided hemothorax. A 49-year-old male with a history of chronic alcoholism was presented with a month of dyspnea. A chest radiography showed a right-sided massive pleural effusion with old-blood-colored fluids and amylase levels of 1,020 IU/L. On the chest computerized tomography (CT), there was pleural effusion and a well-defined tract from the posterior mediastinum to the pseudocyst in the tail of the pancreas. Even with conservative treatment with closed thoracostomy, octreotide and gabexate mesilate, he developed hemothorax. Abdominal CT revealed an increase of the hemorrhagic pancreatic pseudocyst. Distal pancreatectomy with splenectomy and external drainage of the pancreaticopleural fistula on the posterior mediasternum were performed. The patient had an uneventful course and was discharged on the 27th postoperative day. Management of pancreaticopleural fistula is multimodal included medication, endoscopic stenting and surgery. Surgery in pancreaticopleural fistula might be beneficial in selective cases.

Keyword

Pancreaticopleural fistula; Hemothorax; Distal pancreatectomy

MeSH Terms

Alcoholism
Amylases
Drainage
Dyspnea
Fistula
Gabexate
Hemothorax
Humans
Male
Mediastinum
Middle Aged
Octreotide
Pancreas
Pancreatectomy
Pancreatic Pseudocyst
Pancreatitis, Chronic
Pleural Effusion
Splenectomy
Stents
Thoracostomy
Thorax
Amylases
Gabexate
Octreotide

Figure

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  Fig. 1 Chest radiograph on admission showed marked haziness on the right lung field that revealed hemothorax.

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  Fig. 2 Chest CT scan showed fistula (arrow) entering the thorax posterior to the diaphragmatic crura, anterior to the aorta. (A) Horizontal view, (B) Coronal view.

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  Fig. 3 Chest CT scan showed pseudoaneurysm (arrow) located in the pseudocyst.

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  Fig. 4 Magnetic resonance cholangiopancreatography revealed a stenosis (arrow) of main pancreatic duct just proximal to pancreatic cyst.

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  Fig. 5 Preoperative abdomen CT scan showed increased pancreatic pseudocyst (arrows). (A) Horizontal view, (B) Sagittal view.

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  Fig. 6 The tract (arrow) of pancreaticopleural fistula is extended to the mediastinum.

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  Fig. 7 Postoperative abdomen CT performed 13 days post distal pancreatectomy with splenectomy, external drainage showed the resolution of pseudocyst.

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