ABSTRACT
Pancreatico‑pleural fistula is a rare but serious complication of acute and chronic
pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually
massive and recurrent. It is predominately left‑sided but right‑sided and bilateral
effusion does occur. We report four cases of pancreatico‑pleural fistula admitted
to our hospital. Their clinical presentation and management aspects are discussed.
Two patients were managed by pancreatic endotherapy and two patients were managed
conservatively. All four patients improved symptomatically and were discharged and
are on regular follow‑up. Most of these patients would be evaluated for their breathlessness
and pleural effusion delaying the diagnosis of pancreatic pathology and management.
Hence, earlier recognition and prompt treatment would help the patients to recover
from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of
suspicion in patients presenting with chest symptoms or pleural effusion. Extremely
high pleural fluid amylase levels are usual but not universally present. A chest X‑ray,
pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic
resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen)
would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent
or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture
or when medical management fails in patients with dilated or irregular PD. Surgical
intervention may be indicated in patients with complete disruption of PD or multiple
strictures.
Keywords
Endoscopic retrograde cholangiopancreatography
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pancreatic pseudocyst
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pancreatico‑pleural fistula
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pancreatitis
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pleural effusion
