Pancreaticopleural fistulas of different origin: Report of two cases and a review of literature

Abstract

Background: Pancreaticopleural fistula (PPF), a form of internal pancreatic fistula, is a rare complication of acute or chronic pancreatitis or pancreatic trauma.

Case report: We report two cases of PPF resulting in formation of pleural pancreatic pseudocysts. A 35-year-old male alcoholic patient with a history of recurrent episodes of acute pancreatitis was admitted due to a severe dyspnea. A CT scan showed a significant left pleural effusion with a total left lung atelectasis, compression of the mediastinum, and dislocation of the left diaphragm. A follow-up CT showed a fistula between the abdominal pancreatic pseudocyst and the left pleural cavity. The second case was a 13-year-old male patient, who was admitted for a splenic stump excision. Two weeks after the surgery the patient presented a massive pleural amylase-rich effusion. CT exam suggested a PPF, which was indirectly confirmed by a thoracoscopy.

Conclusions: PPF should be considered in cases of massive pleural effusion and encapsulated pleural fluid collections in patients with a history of acute pancreatitis and surgery involving pancreas.

Keywords: acute pancreatitis; pancreaticopleural fistula; pleural effusion; splenectomy.

Figure 1.

Case 1. Massive pleural effusion at the time of admission (A) on chest radiography, (B) on coronal CT scan reconstruction.

Figure 2.

Case 1. Pancreaticopleural fistula (arrows) detected with the second CT examination, which was performed after the thoracocentesis: (A) axial image, (B) coronal reconstruction, (C) sagittal reconstruction.

Figure 3.

Case 2. (A) left pleural effusion, (B) the tail of the pancreas (arrow) located close to the diaphragm, surrounded by a limited fluid collection, (C) pancreaticopleural fistula (arrow).