Research Information System
Surgical Chronicles, vol.20, no.4, pp.152-154, 2015 (Scopus)
© 2015, Surgical Society of Northern Greece. All rights reserved.Background: Pancreaticopleural fistulas are a rare complication of acute and chronic pancreatitis. The chronic pancreatitis leading to pancreaticopleural fistulas is often alcoholic in origin; gallstones, trauma, idiopathic pancreatitis and pancreatic duct anomalies are rare causes. Optimal treatment strategies have been medical management with exocrine suppression with octreotide and endoscopic retrograde cholangiopancreatography stenting of the fistulous pancreatic duct. Surgery is necessary when medical and endoscopic management fails, or the underlying condition requires it. Case presentation: A 60-year-old male reported nonproductive cough, dyspnea, left-sided chest pain, abdominal fullness. Left-sided massive pleural effusion, and a pancreatic cyst attached to left diaphragm and associated with pleura at the paramedian level were detected on abdomino-thoracic computed tomography (CT). Concervative management was planned. During treatment the patient underwent an emergency operation, and rupture of the pancreatic pseudocyst was seen. A cholecystectomy, abdominal lavage and external drainage were performed. Two months later, he was re-admitted to the hospital with complaints of fever, weakness and loss of appetite. Abdomino-thoracic CT showed an abdominal collection located between the pancreatic tail and posterior of the gastric corpus and a cystic lesion in the corpus of the pancreas. The peripancreatic collection was drained using percutaneous drainage, and an endoscopic cystogastrostomy and a stent insertion were performed. Conclusion: Pancreaticopleural fistulas may be complicated by pseudocyst rupture, but the persistence of pseudocysts after drainage of the ruptured pseudocysts make the procedure more complicated. Endoscopic ultrasonography (EUS)-guided cystogastrostomy and a stent insertion, combined with drainage of the abdominal cavity by a percutenous catheter may be used for persistent pseudocyst.