Comprehensive treatment strategy for pancreaticopleural fistula: A rare case report and review of 91 cases

Abstract

Rationale: Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disease, typically resulting from the rupture of a pancreatic pseudocyst or ductal injury. The condition often leads to misdiagnosis due to its nonspecific clinical manifestations, including dyspnea and chest pain.

Patient concerns: A 61-year-old male with a history of alcohol and tobacco use presented with severe dyspnea, chest pain, and cough. He had been diagnosed with acute pancreatitis 9 months prior and intermittently experienced upper abdominal pain and distension post-treatment.

Diagnoses: PPF.

Interventions: The patient underwent thoracic drainage, nasopancreatic duct drainage, and pancreatic duct stent placement, along with parenteral nutrition and somatostatin therapy.

Outcomes: Treatment resulted in resolution of pleural effusion and pseudocyst. The patient had no recurrence during a 5-year follow-up period.

Lessons: This case demonstrates the effectiveness of a comprehensive treatment strategy combining thoracic and pancreatic drainage for PPF. Long-term follow-up is crucial for monitoring recurrence and assessing treatment efficacy. Future research should focus on optimizing treatment plans, particularly regarding the best timing for intervention and improving long-term outcomes.

Figure 1.

(A–F) Illustrate the patient’s bilateral massive pleural effusion upon admission (A), the formation of a pancreatic pseudocyst (B), guidewire entering the pseudocyst during ERCP (C), disappearance of the pseudocyst 1 week after nasopancreatic duct drainage (D), and resolution of pleural effusion (F). ERCP = endoscopic retrograde cholangiopancreatography.

Figure 2.

(A–C) Show that 6 months later, the pancreatic morphology of the patient had returned to normal (A), and the pleural effusion had completely disappeared (B), prompting the removal of the remaining nasopancreatic duct. At the 1-year follow-up, the patient had recovered well with no pancreatic complications (C).