Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2009 Mar;76(3):187-191. Korean.
    Published online Mar 31, 2009.
    https://doi.org/10.4174/jkss.2009.76.3.187
    Copyright © 2009 The Korean Surgical Society
    Case Report

    Pancreaticopleural Fistula with Hemothorax

    Young-Hoon Sul, M.D., Hyoung-Seob Shin, M.D., Kyung-Ha Lee, M.D., Kwang-Sik Chun, M.D. and In-Sang Song, M.D.
      • Department of Surgery, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea.
    Received August 12, 2008; Accepted September 17, 2008.

    Abstract

    Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. We report a case of pancreaticopleural fistula that was presented with right-sided hemothorax. A 49-year-old male with a history of chronic alcoholism was presented with a month of dyspnea. A chest radiography showed a right-sided massive pleural effusion with old-blood-colored fluids and amylase levels of 1,020 IU/L. On the chest computerized tomography (CT), there was pleural effusion and a well-defined tract from the posterior mediastinum to the pseudocyst in the tail of the pancreas. Even with conservative treatment with closed thoracostomy, octreotide and gabexate mesilate, he developed hemothorax. Abdominal CT revealed an increase of the hemorrhagic pancreatic pseudocyst. Distal pancreatectomy with splenectomy and external drainage of the pancreaticopleural fistula on the posterior mediasternum were performed. The patient had an uneventful course and was discharged on the 27th postoperative day. Management of pancreaticopleural fistula is multimodal included medication, endoscopic stenting and surgery. Surgery in pancreaticopleural fistula might be beneficial in selective cases.

    Keywords
    Pancreaticopleural fistula; Hemothorax; Distal pancreatectomy

    Figures

    Fig. 1
    Chest radiograph on admission showed marked haziness on the right lung field that revealed hemothorax.

    Fig. 2
    Chest CT scan showed fistula (arrow) entering the thorax posterior to the diaphragmatic crura, anterior to the aorta. (A) Horizontal view, (B) Coronal view.

    Fig. 3
    Chest CT scan showed pseudoaneurysm (arrow) located in the pseudocyst.

    Fig. 4
    Magnetic resonance cholangiopancreatography revealed a stenosis (arrow) of main pancreatic duct just proximal to pancreatic cyst.

    Fig. 5
    Preoperative abdomen CT scan showed increased pancreatic pseudocyst (arrows). (A) Horizontal view, (B) Sagittal view.

    Fig. 6
    The tract (arrow) of pancreaticopleural fistula is extended to the mediastinum.

    Fig. 7
    Postoperative abdomen CT performed 13 days post distal pancreatectomy with splenectomy, external drainage showed the resolution of pseudocyst.

    References

      1. Rockey DC, Cello JP. Pancreaticopleural fistula. Report of 7 patients and review of the literature. Medicine (Baltimore) 1990;69:332–344.
      1. Amer K, Mahesh B, Ascione R. Pedicled intercostal muscle flap: a simple technique of closing pancreatico-pleural fistula from a thoracic approach. Eur J Cardiothorac Surg 2002;22:831–832.
      1. Oh YS, Edmundowicz SA, Jonnalagadda SS, Azar RR. Pancreaticopleural fistula: report of two cases and review of the literature. Dig Dis Sci 2006;51:1–6.
      1. Boudaya MS, Alifano M, Baccari S, Regnard JF. Hemothorax as the clinical presentation of a pancreaticopleural fistula: report of a case. Surg Today 2007;37:518–520.
      1. Iglesias JI, Cobb J, Levey J, Rosiello RA. Recurrent left pleural effusion in a 44-year-old woman with a history of alcohol abuse. Chest 1996;110:547–549.
      1. Materne R, Vranckx P, Pauls C, Coche EE, Deprez P, Van Beers BE. Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography. Chest 2000;117:912–914.
      1. Fulcher AS, Capps GW, Turner MA. Thoracopancreatic fistula: clinical and imaging findings. J Comput Assist Tomogr 1999;23:181–187.
      1. Neher JR, Brady PG, Pinkas H, Ramos M. Pancreaticopleural fistula in chronic pancreatitis: resolution with endoscopic therapy. Gastrointest Endosc 2000;52:416–418.
      1. Burgess NA, Moore HE, Williams JO, Lewis MH. A review of pancreatico-pleural fistula in pancreatitis and its management. HPB Surg 1992;5:79–86.
      1. Williams SG, Bhupalan A, Zureikat N, Thuluvath PJ, Santis G, Theodorou N, et al. Pleural effusions associated with pancreaticopleural fistula. Thorax 1993;48:867–868.
    Cited by
    Crossref 3
    Google Scholar 
    MeSH Terms
    Alcoholism
    Amylases
    Drainage
    Dyspnea
    Fistula
    Gabexate
    Hemothorax
    Humans
    Male
    Mediastinum
    Middle Aged
    Octreotide
    Pancreas
    Pancreatectomy
    Pancreatic Pseudocyst
    Pancreatitis, Chronic
    Pleural Effusion
    Splenectomy
    Stents
    Thoracostomy
    Thorax
    Metrics
    Share
    Figures
    slide
    slide
    slide
    slide
    slide
    slide
    slide

    1 / 7

    PERMALINK