1
|
Nikpanah M, Morgan DE. Magnetic resonance imaging in the evaluation and management of acute pancreatitis: a review of current practices and future directions. Clin Imaging 2024; 107:110086. [PMID: 38262258 DOI: 10.1016/j.clinimag.2024.110086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
Acute pancreatitis is a condition marked by inflammation of the pancreas and surrounding tissues. While the majority of cases of acute pancreatitis are mild, a minority of severe cases are the primary contributors to the morbidity and mortality attributed to this condition. Retroperitoneal morphologic changes can be detected by utilization of various imaging modalities, and their accurate evaluation is crucial for effective management. Acute pancreatitis is commonly diagnosed using computed tomography (CT). However, there are certain clinical scenarios where magnetic resonance imaging (MRI) may have superiority over CT. In particular, MRI is useful in cases where patients cannot receive iodinated CT contrast, or where there is a need to investigate the underlying cause of acute pancreatitis. Additionally, MRI can be utilized to evaluate ductal disconnection and guide interventions for necrotic collections. The unique features of MRI can be particularly useful, including its ability to provide superior contrast resolution and to offer greater functional information through techniques such as diffusion-weighted imaging. The aim of this review is to discuss the MRI assessment of individuals with acute pancreatitis. Additionally, the recent advances in MRI for evaluation of acute pancreatitis will also be introduced.
Collapse
Affiliation(s)
- Moozhan Nikpanah
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
2
|
Subedi A, Manta D, Mandal A, Subedi AS, Ozden N. Endoscopic management of pancreaticopleural fistula after recurrent acute pancreatitis. Proc (Bayl Univ Med Cent) 2021; 34:687-688. [PMID: 34732987 DOI: 10.1080/08998280.2021.1946314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Abinash Subedi
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Dragos Manta
- Division of Pulmonary and Critical Care, SUNY Upstate University, Syracuse, New York
| | - Amrendra Mandal
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, New York
| | | | - Nuri Ozden
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, New York
| |
Collapse
|
3
|
Murteira F, Costa T, Pinto SB, Francisco E, Gomes AC. Pancreaticopleural fistula: An insidious cause of pleural effusion –case report. J Cardiovasc Thorac Res 2021; 14:67-70. [PMID: 35620754 PMCID: PMC9106946 DOI: 10.34172/jcvtr.2021.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/12/2021] [Indexed: 12/03/2022] Open
Abstract
Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.
Collapse
Affiliation(s)
- Fábio Murteira
- Internal Medicine Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Corresponding Author: Fábio Murteira,
| | - Tiago Costa
- Internal Medicine Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sara Barbosa Pinto
- Internal Medicine Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Elsa Francisco
- General Surgery Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Catarina Gomes
- Gastroenterology Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
4
|
Pancreaticopleural Fistula as a Rare Cause of Both-Sided Pleural Effusion. Case Rep Surg 2021; 2021:6615612. [PMID: 33763281 PMCID: PMC7946485 DOI: 10.1155/2021/6615612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
A pancreaticopleural fistula is a rare cause of pleural effusion. It is a complication of chronic or acute pancreatitis. It is rarely formed to the right or both pleural cavities. Diagnosis and proper treatment often turn out to be difficult and require the cooperation of a multidisciplinary team. The authors present the case of a 59-year-old patient treated for recurrent pleural effusion of unknown origin, first to the left and then to the right pleural cavity. After many months of treatment, the diagnosis of a pancreaticopleural fistula was made. The patient underwent surgery, which finally led to a successful complete recovery. Pancreaticopleural fistula should always be considered in patients with pleural effusion of unknown origin.
Collapse
|
5
|
Kull I, Sottas O, Zender H, Hassan G. Rare case of bilateral pleural effusion caused by pancreaticopleural fistula. BMJ Case Rep 2020; 13:13/9/e234286. [DOI: 10.1136/bcr-2020-234286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A 51-year-old man presented with dyspnoea and basithoracic pain. Chest X-ray revealed bilateral pleural effusion, which was managed by bilateral chest drain placement. The pleural fluid analysis showed elevated lipase. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a large fistula from the tail of the main pancreatic duct to the left pleural space. Definitive treatment was accomplished with ERCP guided large pancreatic stents placement.
Collapse
|
6
|
Kraskovsky V, Mackenzie B, Mador MJ. Pancreaticopleural fistula: an uncommon cause of amylase-rich pleural effusion. BMJ Case Rep 2020; 13:13/8/e236232. [PMID: 32868323 DOI: 10.1136/bcr-2020-236232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pancreaticopleural fistula (PPF) causing pleural effusion as a complication of chronic pancreatitis is a rare finding. We present this finding in a 52-year-old man with a medical history significant for alcohol abuse, acute on chronic pancreatitis and severe chronic obstructive pulmonary disease, who presented with worsening dyspnoea for 3 days. CT scan of the chest showed a new large right-sided pleural effusion. Thoracentesis was performed and pleural fluid analysis showed an amylase-rich, exudative pleural effusion. The effusion reaccumulated within 3 days necessitating repeat thoracentesis. Endoscopic retrograde chloangiopancreatography showed contrast leak through a single disruption in the dorsal pancreatic duct, suspicious for an underlying PPF. The patient underwent stenting of the pancreatic duct with subsequent resolution of right-sided pleural effusion.
Collapse
Affiliation(s)
- Valeri Kraskovsky
- Pulmonary and Critical Care Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Brianne Mackenzie
- Biomedical Informatics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Martin Jeffery Mador
- Pulmonary, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,VA Western New York Healthcare System, Buffalo VA Medical Center, Buffalo, New York, USA
| |
Collapse
|
7
|
Pancreaticopleural Fistula After Cytoreductive Surgery and HIPEC for Pseudomyxoma Peritonei-a Rare Presentation and Rare Complication. Indian J Surg Oncol 2020; 11:174-177. [PMID: 33364691 DOI: 10.1007/s13193-020-01149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022] Open
|
8
|
Vanderbruggen W, Dhooghe V, Bracke B, Hartman V, Roeyen G, Ysebaert D, Van Schil P, Chapelle T. Pancreaticopleural fistula: a rare cause of pleural empyema. Acta Chir Belg 2019; 119:396-399. [PMID: 29716451 DOI: 10.1080/00015458.2018.1470293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aim: Pancreaticopleural fistula (PPF) is a rare complication of acute or chronic pancreatitis. When the pancreatic duct disrupts, pancreatic fluid may leak into the retroperitoneum and fistulate into the pleural cavity. Patients usually present with thoracic complaints, making it hard to suspect an abdominal etiology. Although PPF is uncommon, one must consider this diagnosis in patients with thoracic complaints and a history of alcohol abuse or pancreatitis. Methods: We present an illustrative case and review of the literature on PPF. Results: A 47-year old man was presented with recurrent PPF due to pancreas divisum, pancreatic stones and chronic exudative pancreatitis, resulting in unilateral empyema. After initial conservative treatment, operative measures were needed. We report omentoplasty against the diaphragmatic hiatus in combination with VATS (video-assisted thoracoscopic surgery) thoracotomy with decortication and debridement as a feasible operative option for resolving PPF. Conclusion: PPF is a rare complication of pancreatitis. The diagnosis is difficult to make and can be confirmed by thoracocentesis and proper imaging, preferably MRCP. Treatment options include conservative, endoscopic (ERCP) or surgical measures. Omentoplasty positioned against the diaphragmatic hiatus is a feasible technique for closure of PPF.
Collapse
Affiliation(s)
- Wies Vanderbruggen
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Vicky Dhooghe
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Bart Bracke
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Vera Hartman
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Geert Roeyen
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, University Hospital Antwerp, Antwerp, Belgium
| |
Collapse
|
9
|
Grudzińska E, Pilch-Kowalczyk J, Kuśnierz K. Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom: A case report. Medicine (Baltimore) 2019; 98:e14233. [PMID: 30702580 PMCID: PMC6380760 DOI: 10.1097/md.0000000000014233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms. PATIENT CONCERNS A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission. DIAGNOSIS Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid. INTERVENTIONS Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed. OUTCOMES The surgery led to recovery. Six months later, the patient reported good health and weight gain. LESSONS Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.
Collapse
Affiliation(s)
- Ewa Grudzińska
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Joanna Pilch-Kowalczyk
- Department of Nuclear Medicine and Diagnostic Imaging, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
10
|
Imaging of acquired transdiaphragmatic fistulae and communications. Clin Imaging 2019; 53:78-88. [DOI: 10.1016/j.clinimag.2018.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022]
|
11
|
Daib A, Hellal Y, Boughdir M, Abdallah RB, Kaabar N. [Pancreatic-pleural fistula in children: a rare cause of great abundant pleurisy]. Pan Afr Med J 2017; 26:240. [PMID: 28690754 PMCID: PMC5491726 DOI: 10.11604/pamj.2017.26.240.9003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/08/2016] [Indexed: 01/28/2023] Open
Abstract
La fistule pancréatico-pleurale est une complication très rare des faux kystes du pancréas. L’objectif de notre article est de décrire cette pathologie rare chez l’enfant. On insistera sur l’importance de l’évoquer devant une pleurésie de grande abondance même en l’absence des signes digestifs. Nous décrivons l’observation d’un enfant âgé de 2 ans ayant un faux kyste du pancréas compliqué d’une fistule pleurale découvert suite à une pleurésie de grande abondance sans signes digestifs associés.
Collapse
Affiliation(s)
- Aida Daib
- Département de Chirurgie Pédiatrique, Hôpital Habib Thameur, 1008 Tunis, Tunisia
| | - Youssef Hellal
- Département de Chirurgie Pédiatrique, Hôpital Habib Thameur, 1008 Tunis, Tunisia
| | - Malek Boughdir
- Département de Chirurgie Pédiatrique, Hôpital Habib Thameur, 1008 Tunis, Tunisia
| | - Rabiaa Ben Abdallah
- Département de Chirurgie Pédiatrique, Hôpital Habib Thameur, 1008 Tunis, Tunisia
| | - Nejib Kaabar
- Département de Chirurgie Pédiatrique, Hôpital Habib Thameur, 1008 Tunis, Tunisia
| |
Collapse
|
12
|
Gupta S, Gaikwad N, Samarth A, Sawalakhe N, Sankalecha T. Efficacy of Pancreatic Endotherapy In Pancreatic Ascites And Pleural Effusion. Med Sci (Basel) 2017; 5:medsci5020006. [PMID: 29099022 PMCID: PMC5635787 DOI: 10.3390/medsci5020006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 01/20/2023] Open
Abstract
Pancreatic ascites and effusion is a challenging complication to manage, hence our aim was to evaluate the efficacy of pancreatic endotherapy in pancreatic ascites and pleural effusion. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) with a pancreatogram and pancreatic stent placement across the leak in patients with pancreatic ascites/effusion. A total of 53 patients were included after successful cannulation. The male:female ratio was 7.8:1. The pancreatogram revealed a leak from the pancreatic duct in 20/53 (37.73%) patients. The most common leak site was the pancreatic body in 10/53 (18.9%) patients followed by the tail in 6/53 (11.32%) patients and the genu in 4/53 (7.5%) patients. In 29/53 (54.7%) patients, stent was placed beyond the leak site. Sphincterotomy was done in 7/53 (13.2%) patients, and in five patients with an obscure leak site, stent was placed empirically. A total of 39/53 (73.6%) patients benefited in terms of achieving the complete resolution of ascites and pleural effusion. The factors which were significant for the success of pancreatic endotherapy in the multivariate analysis were the site of the pancreatic ductal leak (p value = 0.008) and the ability of the stent to cross the leak site (p value = 0.004). To sum up, bridging the pancreatic ductal leak by stent offers a high rate of success. Pancreatic endotherapy is less invasive and highly effective in managing pancreatic ascites/pleural effusion.
Collapse
Affiliation(s)
- Sudhir Gupta
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur,Maharashtra, 440003, India.
| | - Nitin Gaikwad
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur,Maharashtra, 440003, India.
| | - Amol Samarth
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur,Maharashtra, 440003, India.
| | - Niraj Sawalakhe
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur,Maharashtra, 440003, India.
| | - Tushar Sankalecha
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur,Maharashtra, 440003, India.
| |
Collapse
|
13
|
Hirosawa T, Shimizu T, Isegawa T, Tanabe M. Left pleural effusion caused by pancreaticopleural fistula with a pancreatic pseudocyst. BMJ Case Rep 2016; 2016:bcr-2016-217175. [PMID: 27558195 DOI: 10.1136/bcr-2016-217175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. The authors described a case of a man with medical history of alcohol-related chronic pancreatitis, presented with dyspnoea. The roentgenogram showed a massive left pleural effusion. Additional work-up revealed a pancreaticopleural fistula and amylase-rich pleural effusion. His respiratory state improved after the insertion of chest drainage tube. During his admission, conservative and endoscopic therapy was required for the treatment of his complication of mediastinal abscess and arterial aneurysm in the pancreatic pseudocyst.
Collapse
Affiliation(s)
- Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Takuya Isegawa
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Mayo Tanabe
- Showa University Koto Toyosu Hospital, Digestive Diseases Center, Tokyo, Japan
| |
Collapse
|
14
|
Pancreatico-pleural fistula: A rare cause of massive right-sided pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
15
|
Tanaka T, Kuroki T, Kitasato A, Adachi T, Ono S, Hirabaru M, Matsushima H, Takatsuki M, Eguchi S. Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system. Pancreatology 2013; 13:621-4. [PMID: 24280580 DOI: 10.1016/j.pan.2013.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 08/18/2013] [Accepted: 08/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Internal pancreatic fistula (IPF) is a well-recognized complication of pancreatic diseases. Although there have been many reports concerning IPF, the therapy for IPF still remains controversial. We herein report our experiences with endoscopic transpapillary pancreatic stent therapy for IPF and evaluate its validity. METHOD Six patients with IPF who presented at our department and received endoscopic transpapillary pancreatic stent therapy were investigated, focusing on the clinical and imaging features as well as treatment strategies, the response to therapy and the outcome. RESULTS All patients were complicated with stenosis or obstruction of the main pancreatic duct, and in these cases the pancreatic ductal disruption developed distal to the areas of pancreatic stricture. The sites of pancreatic ductal disruption were the pancreatic body in five patients and the pancreatic tail in one patient. All patients received endoscopic stent placement over the stenosis site of the pancreatic duct. Three patients improved completely and one patient improved temporarily. Finally, three patients underwent surgical treatment for IPF. All patients have maintained a good course without a recurrence of IPF. CONCLUSION Endoscopic transpapillary pancreatic stent therapy may be an appropriate first-line treatment to be considered before surgical treatment. The point of stenting for IPF is to place a stent over the stenosis site of the pancreatic duct to reduce the pancreatic ductal pressure and the pseudocyst's pressure.
Collapse
Affiliation(s)
- Takayuki Tanaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Ozbek S, Gumus M, Yuksekkaya HA, Batur A. An unexpected cause of pleural effusion in paediatric emergency medicine. BMJ Case Rep 2013; 2013:bcr-2013-009072. [PMID: 23595187 DOI: 10.1136/bcr-2013-009072] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pancreaticopleural fistula (PPF) is an uncommon complication of chronic pancreatitis leading to a large and recurrent pleural effusion. Since the patients presented predominantly with respiratory symptoms, diagnosis and treatment were often delayed. We describe a child who was admitted to our paediatric emergency department with an acute onset of dyspnoea and unilateral massive pleural effusion caused by PPF. Multidetector CT is an easily accessible method that is able to show both the thoracic and abdominal findings non-invasively. The clinical and imaging features of this unusual entity are discussed.
Collapse
Affiliation(s)
- Seda Ozbek
- Department of Radiology, Selcuk University Medical Faculty, Konya, Turkey.
| | | | | | | |
Collapse
|
17
|
Shah D, Desai AB, Salvi B. Pancreaticopleural fistula complicating chronic pancreatitis. BMJ Case Rep 2012; 2012:bcr-03-2012-6038. [PMID: 22878984 DOI: 10.1136/bcr-03-2012-6038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Pancreaticopleural fistula is an extremely rare complication of chronic pancreatitis with characteristic feature that it may appear in the absence of changes of acute pancreatitis. We present a case of a 32-year-old man whose CT scan showed multiple pseudocysts along the body and tail of the pancreas, left crus of diaphragm and in the posterior mediastinum with associated splenoportal thrombosis. MR cholangiopancreatography imaging diagnosed the case as a pancreatico-pleural fistula, with the fistulous tract connecting distal body and tail of the pancreas to the posterior mediastinum through a diaphragmatic hiatus with right-sided mild-to-moderate pleural effusion. Meanwhile the patient was treated conservatively for his acute symptoms that included pleural tap also. Finally, endoscopic retrograde cholangiopancreatography was done and minor papilla papillotomy was performed and a stent was placed. Knowledge about such cases would help one to be aware of such a rare but dangerous complication, so that timely and correct diagnosis and management can be undertaken.
Collapse
Affiliation(s)
- Dharita Shah
- Department of Radiology, VS General Hospital, Ahmedabad, Gujarat, India.
| | | | | |
Collapse
|
18
|
Koide T, Saraya T, Nakajima A, Kurai D, Ishii H, Goto H. A 54-Year-Old Man With an Uncommon Cause of Left Pleural Effusion. Chest 2012; 141:560-563. [DOI: 10.1378/chest.11-1493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
19
|
Pancreaticopleural fistula: revisited. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:815476. [PMID: 22454555 PMCID: PMC3290893 DOI: 10.1155/2012/815476] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/31/2011] [Indexed: 11/30/2022]
Abstract
Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT. Endoscopic retrograde cholangiopancreaticography (ECRP) or magnetic resonance cholangiopancreaticography (MRCP) may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management. There is, however, a lack of clarity regarding the management, and the literature is reviewed here to assess the present view on its pathogenesis, investigations, and management.
Collapse
|
20
|
Fitchett JM, Beaumont A, Davies IL, Lewis MH. An extreme presentation of pancreatic pseudocyst. Ann R Coll Surg Engl 2010; 92:W21-3. [PMID: 20056055 DOI: 10.1308/147870810x476683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pancreatitis is a serious and common presentation to general surgery departments. There are many complications associated with pancreatitis and we present an undescribed presentation of a pancreatic pseudocyst and include its management strategy.
Collapse
Affiliation(s)
- Jason M Fitchett
- General Surgery Department, Royal Glamorgan Hospital, Llantrisant, UK
| | | | | | | |
Collapse
|
21
|
Sul YH, Shin HS, Lee KH, Chun KS, Song IS. Pancreaticopleural Fistula with Hemothorax. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.3.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Young-Hoon Sul
- Department of Surgery, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyoung-Seob Shin
- Department of Surgery, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung-Ha Lee
- Department of Surgery, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Kwang-Sik Chun
- Department of Surgery, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| | - In-Sang Song
- Department of Surgery, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| |
Collapse
|
22
|
|
23
|
|
24
|
Bishop JR, McClean P, Davison SM, Sheridan MB, Zamvar V, Humphrey G, Stringer MD. Pancreaticopleural fistula: a rare cause of massive pleural effusion. J Pediatr Gastroenterol Nutr 2003; 36:134-7. [PMID: 12500009 DOI: 10.1097/00005176-200301000-00025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jon R Bishop
- Children's Liver & GI Unit, St Jome's University Hospital, Leeds, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
25
|
Kin H, Kiriya K, Mori S, Suzuki N, Mukai S, Yamaguchi K, Mochizuki T, Asano T, Kojima H, Ito K, Kojima K, Kubota Y, Inoue K. PANCREATIC PLEURAL EFFUSION SUCCESSFULLY TREATED BY ENDOSCOPIC PANCREATIC DUCT DRAINAGE COMBINED WITH EXTRACORPOREAL SHOCK‐WAVE LITHOTRIPSY: REPORT OF A CASE. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2001.00087.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Hideyuki Kin
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Kei‐ichi Kiriya
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Shigeo Mori
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Naoyuki Suzuki
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Shin‐ichi Mukai
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Kyoichi Yamaguchi
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Tsutomu Mochizuki
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Takeshi Asano
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Hiroyoshi Kojima
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Kazuki Ito
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Koichi Kojima
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Yoshitsugu Kubota
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Kyoichi Inoue
- *Department of Gastroenterology, Shizuoka General Hospital, Shizuoka and † Third Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| |
Collapse
|
26
|
Neher JR, Brady PG, Pinkas H, Ramos M. Pancreaticopleural fistula in chronic pancreatitis: resolution with endoscopic therapy. Gastrointest Endosc 2000; 52:416-8. [PMID: 10968864 DOI: 10.1067/mge.2000.108296] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J R Neher
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida College of Medicine, Tampa, Florida, USA
| | | | | | | |
Collapse
|
27
|
Affiliation(s)
- B Y Safadi
- Department of Surgery, Mt. Sinai Medical Center, and the Department of Surgery, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | | |
Collapse
|
28
|
Dhar P, Tomey S, Jain P, Azfar M, Sachdev A, Chaudhary A. Internal pancreatic fistulae with serous effusions in chronic pancreatitis. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:608-11. [PMID: 8859161 DOI: 10.1111/j.1445-2197.1996.tb00830.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Serous effusions in chronic pancreatitis are infrequent but persistent. These occur usually as a consequence of internal pancreatic fistulae and commonly involve the pleural cavity or peritoneum. METHODS To assess strategies in operative management, the records of 12 patients who underwent surgery for internal pancreatic fistula with underlying chronic pancreatitis were reviewed retrospectively. Seven patients had pancreatic ductal calculi. Three cases underwent external drainage. Three cases with leaking pseudocysts underwent cystojejunostomy-en-Y. Three cases with ductal dilatation or calculi underwent lateral pancreaticojejunostomy and three patients had caudal pancreatectomy for distal disease. RESULTS Eight patients were completely controlled of all symptoms, with no sequelae. One case each had recurrent pancreatitis and ascites but did not require re-operation. There were two deaths: one with massive haematemesis and one with pre-existent multi-organ failure and sepsis. CONCLUSIONS Pancreatic duct stones may be causally associated with internal pancreatic fistulae. Delineation of ductal anatomy and pathological aberrations of the pancreas, including determination of the leak site, was of paramount importance in planning surgery. Peroperative ductography proved the most useful in this regard.
Collapse
Affiliation(s)
- P Dhar
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi, India
| | | | | | | | | | | |
Collapse
|
29
|
Wakefield S, Tutty B, Britton J. Pancreaticopleural fistula: a rare complication of chronic pancreatitis. Postgrad Med J 1996; 72:115-6. [PMID: 8871464 PMCID: PMC2398381 DOI: 10.1136/pgmj.72.844.115] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pancreaticopleural fistula is an uncommon sequelae of pancreatitis. The condition is often elusive, as respiratory rather than abdominal symptoms usually predominate and the fistula can be difficult to demonstrate radiologically. Confirmation is by demonstrating a high amylase content in the pleural aspirate relative to the serum. About half the fistulae will close with conservative treatment but persistent or recurrent effusions, often associated with stenosis or disruption of the main pancreatic duct, are an indication for surgery. The long-term outcome is good in 80-95% of cases. We report five patients with pleural effusion of pancreatic origin due to pancreaticopleural fistula.
Collapse
Affiliation(s)
- S Wakefield
- John Radcliffe Hospital, Headington, Oxford, UK
| | | | | |
Collapse
|