[Pancreatogenic pleuritis and pancreatico-pleural fistula: pathogenesis, diagnosis and therapy].
Two patients with alcohol-induced chronic pancreatitis are presented, who developed a massive pleural effusion characterized by an extremely high amylase content. We report our diagnostic observations and therapeutic experiences in non-operative and surgical management. A review on the pertinent literature is given. Acute pancreatitis frequently (10-20%) occurs in conjunction with small left-sided pleural effusions. These effusions usually undergo spontaneous regression. Their genesis is explained by vascular transdiaphragmatic inflammatory involvement of the pleural space. In patients with alcohol-induced chronic pancreatitis pleural effusion is, however, a rare event. The activity of the pancreas-specific enzymes (amylase, lipase) are extremely high. The most likely underlying pathogenetic mechanism is transdiaphragmatic lymphatic transfer of pancreatic secretions to the subpleural space. A rare cause is the formation of a pancreatico-pleural fistula. The use of endoscopic retrograde pancreatography (ERP) can reveal the site of pancreatic fistulas to the pleural cavity.
Sachs
M
M
Klinik für Allgemein- und Abdominalchirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main.
Falley
J
J
Schachtel
U
U
D000437:Alcoholism / Q000150:complications* / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D005402:Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000601:surgery*; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D000516:alpha-Amylases / Q000378:metabolism
D000516:alpha-Amylases
Pankreatogene Pleuritis und pankreatiko-pleurale Fistel: Pathogenese, Diagnostik und Therapie.