Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020;59(11):1427-1431.
doi: 10.2169/internalmedicine.4258-19. Epub 2020 Jun 1.

Internal Pancreatic Fistula with Pleural Effusion Showing Elevated Levels of Amylase That Emerged 29 Years after Abdominal Surgery

Taro Yoneda  1 , Hayato Koba  1 , Tsukasa Ueda  1 , Hitoshi Oumura  1 , Nobuyuki Katayama  2 , Kazuo Kasahara  3
Affiliations
Case Reports

Internal Pancreatic Fistula with Pleural Effusion Showing Elevated Levels of Amylase That Emerged 29 Years after Abdominal Surgery

Taro Yoneda et al. Intern Med. 2020.

Abstract

A 65-year-old woman presented to a hospital with complaints of dyspnea and lumbar pain. Chest computed tomography (CT) showed left pleural effusion. Thoracentesis showed pleural effusion with elevated levels of amylase. Enhanced CT showed fluid accumulation from the thoracic crus of the diaphragm to the left iliopsoas muscle. Based on the postoperative notes following left nephrectomy performed 29 years ago, we suspected that the internal pancreatic fistula had resulted from the postoperative scar. Conservative management was performed. However, occlusion of the pancreatic fistula failed. Subsequently, she underwent pancreatic body tail spleen merger resection, and the pleural effusion disappeared.

Keywords: amylase; iliopsoas muscle; internal pancreatic fistula; pancreatitis; pleural effusion.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Chest X-ray (A) and chest computed tomography (B) showed left pleural effusion.
Figure 2.
Figure 2.
Contrast-enhanced thoracoabdominal computed tomography showing fluid accumulation in the left chest cavity (A), left crus of the diaphragm (B), and left iliopsoas muscle (C).
Figure 3.
Figure 3.
The accumulation of the contrast agent on the left side of the vertebra of the body was confirmed by endoscopic retrograde cholangiopancreatography (A). Immediate contrast-enhanced abdominal computed tomography showing leakage of the contrast agent outside the pancreas (B).
Figure 4.
Figure 4.
Surgical specimen of pancreatosplenectomy. The tail and anterior surface of the pancreas had severely coalesced (A), and severe crush wound present (B).
Figure 5.
Figure 5.
Course of treatment.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Semba D, Wada Y, Ishihara Y, et al. . Massive pancreatic pleural effusion: pathogenesis of pancreatic duct disruption. Gastroenterology 1999: 528-532, 1990. - PubMed
    1. Gluck CA, Barkin TS. Pancreatic ascites. In: Bockus Gastroenterology. Berk JE, Ed. WB Saunders, Philadelphia, 1985: 4089-4093.
    1. King JC, Reber HA, Shiraga S, et al. . Pancreatic-pleural fistula is best managed by early operative intervention. Surgery 147: 154-159, 2010. - PubMed
    1. Abe N, Sugiyama M, Suzuki Y, et al. . Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg 191: 198-200, 2006. - PubMed
    1. Masuda F, Hishinuma H, Ihzuka N. Pancreatic cutaneous fistula as a complication of left nephrectomy. Hinyokika Kiyo 31: 1619-1621, 1985(in Japanese, Abstract in English). - PubMed

Publication types