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Review
. 2020 Jun 3;20(1):274.
doi: 10.1186/s12887-020-02174-x.

Pancreaticopleural fistula in children with chronic pancreatitis: a case report and literature review

Jia-Yu Zhang  1 , Zhao-Hui Deng  1 , Biao Gong  2
Affiliations
Review

Pancreaticopleural fistula in children with chronic pancreatitis: a case report and literature review

Jia-Yu Zhang et al. BMC Pediatr. .

Abstract

Background: Pancreaticopleural fistula (PPF) is a very rare and critical complication of pancreatitis in children. The majority of publications relevant to PPF are case reports. No pooled analyses of PPF cases are available. Little is known about the pathogenesis and optimal therapeutic schedule. The purpose of this study was to identify the pathogenesis and optimal therapeutic schedule of PPF in children.

Case presentation: The patient was a 13-year-old girl who suffered from intermittent chest tightness and dyspnea for more than 3 months; she was found to have chronic pancreatitis complicated by PPF. The genetic screening revealed SPINK1 mutation. She was treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde pancreatic drainage (ERPD); her symptoms improved dramatically after the procedures.

Conclusions: PPF is a rare pancreatic complication in children and causes significant pulmonary symptoms that can be misdiagnosed frequently. PPF in children is mainly associated with chronic pancreatitis (CP); therefore, we highlight the importance of genetic testing. Endoscopic treatment is recommended when conservative treatment is ineffective.

Keywords: Case report; Child; Chronic pancreatitis; Pancreaticopleural fistula.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
An air-fluid level and atelectasis can be seen on the chest x-ray (left) and computed tomography (right) images, which showing massive left hydropneumothorax
Fig. 2
Fig. 2
Abdominal CT showed a small low-density lesion at the distal pancreas, accompanied by a dilatation of the main pancreatic duct (blue arrow) and the pancreatic pseudocyst (yellow arrow)
Fig. 3
Fig. 3
a An MRCP revealed dilatation of the main pancreatic duct (blue arrow). b An MRCP revealed an abnormal tubular structure from the pancreatic pseudocyst to the pleural cavity (yellow arrow)
Fig. 4
Fig. 4
a Endoscopic retrograde cholangiopancreatography (ERCP) showed segmental stenosis and dilatation of the pancreatic duct (blue arrow) and a pseudocyst at the pancreatic body and tail (yellow arrow). b ERCP showed a stent was placed into the pancreatic duct
Fig. 5
Fig. 5
Flowchart for the treatment strategy in children with pancreaticopleural fistula
See this image and copyright information in PMC

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