Pancreaticopleural fistula is an extremely rare complication of pancreatitis. We present a case of pancreaticopleural fistula in a patient with recurrent acute pancreatitis who presented with right-sided symptomatic pleural effusion. Pancreatic sphincterotomy and pancreatic duct stenting led to resolution of pleural effusion and withdrawal of the chest tube within 3 weeks.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8545064PMC
http://dx.doi.org/10.1080/08998280.2021.1946314DOI Listing

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Rationale: Pancreaticopleural fistula (PPF) is an infrequent etiology of pleural effusion, characterized by nonspecific thoracic symptoms, which often leads to misdiagnosis and subsequent severe complications. Consequently, early diagnosis is crucial for effective management and the prevention of adverse outcomes. This report presents a rare case of PPF causing bilateral pleural effusions, aiming to enhance clinical recognition of this condition.

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Pancreaticopleural fistula: a rare aetiology of pleural effusion.

BMJ Case Rep

December 2024

General and Upper Gastrointestinal Surgery, NHS Lanarkshire, Bothwell, South Lanarkshire, UK.

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis, which clinically presents as a pleural effusion and often with an absence of typical abdominal symptoms associated with pancreatic disease.We describe a man in his early 50s who presented to the emergency department with pleuritic chest pain and progressive breathlessness with a history of alcohol excess. Chest X-ray demonstrated a bilateral pleural effusion with a dark red amylase-rich exudate on needle aspiration, necessitating a chest drain insertion.

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We present a case of a 52-year-old man with chronic toxic pancreatitis and history of multiple hospital admissions secondary to pancreatitis exacerbation. Due to persistent respiratory symptoms a thoracoabdominal computerized tomography (CT) was performed. The CT showed a new significant right pleural effusion as well as inflammatory changes secondary to acute pancreatitis.

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A pancreatic fistula is defined as the leakage of pancreatic fluid into another organ or compartment because of pancreatic duct disruption or pseudocyst formation. It is most often seen in middle-aged men between 40 and 50, particularly in patients who have a history of chronic alcoholism and pancreatitis. The tract may fistulae into the pleura, creating a pancreaticopleural fistula, an exceedingly rare condition presenting as a recurrent pleural effusion and extremely high amylase levels, a key distinguishing factor in diagnosis.

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