[A rare complication of chronic pancreatitis: pancreatico-pleural fistula]

Abstract

Pleural effusion is a rare complication of chronic pancreatitis. We report a case observed in a 39-year-old patient hospitalized for dyspnea and pain in the lower left thorax. Chest x-ray revealed left pleural effusion. The exudative pleural fluid contained a very high amylase level. CT-scan revealed a pseudo-cyst of the tail of the pancreas extending into contact with the diaphragm and the chronic pancreatitis lesions. Medical treatment associating thoracic drainage, somatostatin analog, and antibiotics was unsuccessful. Thoracoscopic pleural decortication was performed. The patient then developed pneumonia involving the left base. A new antibiotic regimen was delivered and the pseudocyst was drained percutaneously under CT guidance. The clinical course was favorable at six months with partial involution of the pseudocyst and regression of the pulmonary images.