Pediatr Gastroenterol Hepatol Nutr.  2019 Nov;22(6):601-607. 10.5223/pghn.2019.22.6.601.

Endoscopic Management of Pancreaticopleural Fistula in a Child with Hereditary Pancreatitis

• Lee D
• Lee EJ
• Kim JW
• Moon JS
• Kim YT
• Ko JS

• KMID: 2462102
• DOI: http://doi.org/10.5223/pghn.2019.22.6.601

Abstract

Pancreaticopleural fistula (PPF) a fistulous connection between the pancreas and pleural space due to prolonged chronic pancreatitis (CP). PPF is a very rare complication which presents in 0.4% of chronic pancreatitis cases, especially among children. We report a case involving a 3-year-old boy who presented with pleural effusion caused by a PPF, a complication of hereditary pancreatitis, which was, for the first time in Korea, successfully managed with endoscopic treatment. Chest radiography and computed tomography showed massive pleural effusion. Percutaneous catheter drainage was performed. High amylase levels were observed in the pleural fluid and serum, suggesting PPF. The patient was managed with bowel rest and octreotide infusion. Endoscopic retrograde cholangiopancreatography revealed CP, and pleural effusion was successfully managed with stent placement. PRSS1 genetic screening revealed R122H mutation.

Keyword

Pancreaticopleural fistula; Endoscopic retrograde cholangiopancreatography; Chronic pancreatitis; Pancreatic fistula; Pleural effusion

MeSH Terms

Amylases
Catheters
Child*
Child, Preschool
Cholangiopancreatography, Endoscopic Retrograde
Drainage
Fistula*
Genetic Testing
Humans
Korea
Male
Octreotide
Pancreas
Pancreatic Fistula
Pancreatitis*
Pancreatitis, Chronic
Pleural Effusion
Radiography
Stents
Thorax
Amylases
Octreotide

Figure

• 

  Fig. 1 Chest radiography (left) and computed tomography (right) images showing massive left-sided pleural effusion.

• 

  Fig. 2 Magnetic resonance cholangiopancreatography image showing suspicious narrowing of the proximal main pancreatic duct, probably due to a stone or sludge. A tract near the left diaphragm is thought to be the fistula that connects to the pleural cavity (arrow).

• 

  Fig. 3 Endoscopic retrograde cholangiopancreatography image showing a tortured pancreatic duct stricture due to chronic pancreatitis. A single pigtail plastic stent (5 Fr, 5 cm) was inserted through the minor papilla.

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  Fig. 4 Family pedigree of the patient. The patient's uncle underwent 80% distal pancreatectomy due to chronic pancreatitis with multiple stones, and the grandfather had pancreatic cancer. The great-aunt and first cousin also had pancreatic diseases.

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