Pancreaticopleural fistula in children: Report of 2 cases

Abstract

Pancreaticopleural fistula is an extremely rare complication of pancreatic duct injury. The reported treatments include conservative approaches, such as pleural drainage, and interventional approaches, such as sphincter stenting via endoscopic retrograde cholangiopancreatography and surgery. However, no specific consensus treatment has been defined. We present 2 cases of pediatric patients with pancreaticopleural fistulas due to pancreatic trauma and pancreatitis that were successfully treated surgically. The most prominent symptom in both cases was dyspnea caused by pleural effusion. Thoracoabdominal computed tomography scans showed large pleural effusions and visible fistulas from the pancreatic duct to the thoracic cavity through the esophageal hiatus and aortic hiatus. Following unsuccessful conservative treatment using pleural drainage, the 2 patients underwent surgical fistulo-jejunostomy and cystojejunostomy. Both patients were stable and were discharged on postoperative days 10 and 12. Conservative treatment for pancreaticopleural fistula often fails, and a surgical approach, such as fistulo-jejunostomy and cystojejunostomy, can serve as an efficacious management strategy when conservative treatment fails.

Keywords: Cystojejunostomy; Fistulo-jejunostomy; Pancreaticopleural fistula.

Fig 1

Right pleural effusion (asterisks) and pancreaticopleural fistula (arrows) on the coronal (A) and axial planes (B) of thoracoabdominal computed tomography scans performed for Patient 1.

Fig. 2

Intraoperative image of the pancreaticopleural fistula in Patient 1.

Fig. 3

Thoracoabdominal computer tomography scan of Patient 2 showed a pseudocyst originating from the tail of the atrophic and calcified pancreas (A). The abdominal proportion (B) and the mediastinal proportion of the pseudocyst (C).