Pancreaticopleural fistula: Report of two cases and review of literature

Abstract

Pancreaticopleural fistula is a rare clinical problem. It is seen rarely in acute and chronic pancreatitis or after pancreatic duct trauma. It poses a diagnostic challenge. It may be silent or can present with predominant chest or abdominal symptoms. The diagnosis should be suspected if a patient presents with pleural effusion in a setting of pancreatitis or alcohol intake. The significantly raised amylase in the pleural fluid offers an important clue to the diagnosis. Computed tomography is the initial imaging of choice, which defines the pancreatic as well as chest abnormalities. The therapeutic options include medical, endoscopic, as well as surgical interventions. Although, there is no data comparing the endoscopic and surgical interventions, patients are generally treated with medical and endoscopic therapies. Surgery is reserved for those who fail medical and endoscopic therapies. Here we report two cases of pancreaticopleural fistulas that were treated successfully by endoscopic retrograde cholangiopancreatography and placement of a plastic stent in the main pancreatic duct.

Keywords

• endoscopic retrograde cholangiopancreatography
• pancreaticopleural fistula
• stenting