Diagnosis and Management of Pancreaticopleural Fistula in Children

Pancreaticopleural fistula in children: Report of 2 cases

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.

Pancreaticopleural fistula in a child with chronic pancreatitis harboring compound SPINK1 variants

BACKGROUND

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis (CP) that requires a high index of clinical suspicion in the patient who presents with a pleural effusion. Visualizing the fistula tract from the pancreatic duct to the pleural space by radiological imaging provides confirmation of this complication.

CASE PRESENTATION

A 9-year-old boy who presented with massive right pleural effusion secondary to PPF, a complication of CP from a genetic mutation involving two mutations of SPINK1. We successfully managed the case with by endoscopic pancreatic duct stent placement after failure of conservative treatment approaches.

CONCLUSIONS

PPF is a rare but serious complication of CP in all ages. The diagnosis of PPF in children requires a high index of clinical suspicion and should be considered in the differential diagnosis of massive pleural effusion where pancreatic pathology is present. A high level of pleural fluid amylase and the results from radiological imaging when the patients have symptoms play essential roles in the diagnosis of PPF. Currently, Magnetic resonance cholangiopancreatigraphy (MRCP) is the imaging modality of choice. Endoscopic therapy and surgery are treatment options for patients who do not respond to conservative therapy.

Pediatric pulmonology 2019 year in review: rare and diffuse lung disease

Pediatric Pulmonology publishes original research, review articles, and case reports on topics related to a wide range of children's respiratory disorders. Here we review manuscripts published in 2019 in this journal and others on (1) anatomic lung, airway, and vascular malformations, (2) children's interstitial lung disease, and (3) primary ciliary dyskinesia and non-cystic fibrosis bronchiectasis.