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Review
. 2020 Jun 5;99(23):e20657.
doi: 10.1097/MD.0000000000020657.

Endoscopic management of pancreaticopleural fistula in a pediatric patient: A case report and literature review

Jing Yang  1 , Lei Lu, Hang-Bin Jin, Jian-Feng Yang, Xiao-Feng Zhang
Affiliations
Review

Endoscopic management of pancreaticopleural fistula in a pediatric patient: A case report and literature review

Jing Yang et al. Medicine (Baltimore). .

Abstract

Introduction: Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disorders. As the clinical presentations of PPF are often deceptive, it can cause a delay in the timely diagnosis and proper treatment. PPF is extremely uncommon in pediatric patients, and diagnostic and management strategies for PPF among pediatric patients are scanty.

Patient concerns: A 12-year-old girl presented with cough and dyspnea owing to massive right-side pleural effusion confirmed by Chest X-ray. Biochemical examination of pleural effusion revealed a significant elevation of amylase level. Imaging modalities showed dilated pancreatic duct and fistulous tract connecting pancreatic duct and right thorax.

Diagnosis: Chronic pancreatitis with PPF was diagnosed.

Interventions: Medical therapy was initially attempted for 2 weeks. Endoscopic therapy with naso-pancreatic drainage tube placement was then performed without any complications after failed medical therapy.

Outcomes: The patient has remained healthy and symptom-free during 2 years of follow-up.

Conclusion: When pediatric patients presented with recurrent pleural effusion with unknown etiology, PPF should be taken into consideration. Pleural effusion amylase level is the most important laboratory test and magnetic resonance cholangiopancreatography is recommended to visualize the fistula. Optimal management of PPF should be based on pancreatic duct morphology.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Chest X-ray showed massive pleural effusion in the right thorax.
Figure 2
Figure 2
Abdominal CT showed dilated irregular pancreatic duct. CT = computed tomography.
Figure 3
Figure 3
MRCP showed dilated pancreatic duct and a fistulous tract originating from pancreatic duct and extended to the right thorax. MRCP = magnetic resonance cholangiopancreatography.
Figure 4
Figure 4
ERCP showed a dilated main pancreatic duct with multiple filling defect. ERCP = endoscopic retrograde cholangiopancreatography.
Figure 5
Figure 5
Repeated pancreatogram showed amelioration of the dilated pancreatic duct.
Figure 6
Figure 6
Presenting symptoms of 25 previously published pediatric patients with PPF. PPF = pancreaticopleural fistula.
See this image and copyright information in PMC

References

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