Pancreatic pleural effusion due to ductal disruption upstream of a tight ductal stricture in patient with chronic calcific pancreatitis: Successful management with pancreatic sphincterotomy and dilatation of ductal stricture by Guide Wire

Abstract

Endoscopic therapy has evolved as the standard of care for pancreatic pleural effusion and pancreatic ascites. Endoscopic retrograde cholangiopancreatography and bridging the disruption of ductal disruption with stent placement is the treatment of choice. However, it may not be always possible to negotiate tight pancreatic duct (PD) strictures or stricture stone complex, and endoscopic sphincterotomy alone may not be sufficient. We report a 53-year-old male who had chronic calcific pancreatitis with bilateral pancreatic pleural effusion and a tight stricture at head body junction, across which conventional endoscopic accessories could not be negotiated except for the 0.035 inch guidewire, which we kept across the stricture for 48 h for guidewire induced stricture dilation. This led to the complete resolution of symptoms and pancreatic pleural effusion. Combination of endoscopic sphincterotomy and guide wire induced stricture dilation can be used as rescue technique in cases of very tight PD strictures with complications such as pancreatic pleural effusion.

Keywords

• duct disruption
• endoscopic sphincterotomy
• ethanol
• pancreatic ducts
• guidewire
• pancreatic stricture
• pancreatitis
• pleural effusion