Diagnosis and management of pancreaticopleural fistula
- 23 April 2013
- journal article
- case report
- Published by Medknow in Singapore Medical Journal
- Vol. 54 (4), 190-194
- https://doi.org/10.11622/smedj.2013071
Abstract
Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.Keywords
This publication has 23 references indexed in Scilit:
- Optimizing management of pancreaticopleural fistulasWorld Journal of Gastroenterology, 2011
- Pancreatic–pleural fistula is best managed by early operative interventionSurgery, 2010
- Two Patients with Chronic Pancreatitis Complicated by a Pancreaticopleural FistulaCase Reports in Gastroenterology, 2009
- Pancreaticopleural FistulaPancreas, 2009
- Endoscopic Transpapillary Stenting of Pancreatic Duct DisruptionDigestive Surgery, 2006
- Endoscopic Management of Pancreaticopleural Fistulas: A Report of Three PatientsEndoscopy, 2006
- Pancreaticopleural Fistula: Report of Two Cases and Review of the LiteratureDigestive Diseases and Sciences, 2006
- Endoscopic Ultrasound-Assisted Rendezvous Maneuver to Achieve Pancreatic Duct Drainage in Obstructive Chronic PancreatitisEndoscopy, 2005
- Isolated massive pleural effusion caused by pancreatico-pleural fistulaZeitschrift für Gastroenterologie, 2000
- Pleural Effusion with Pancreaticopleural FistulaBMJ, 1973