Surgical treatment for right pleural effusions caused by pancreaticopleural fistula.
A 56-year-old man with a history of alcohol abuse presented with exertional dyspnea. A chest radiography showed a massive right pleural effusion with sanguineous pleural fluid and an amylase level of 97,188 IU/L. Despite conservative treatment with no oral intake, total parenteral nutrition and repeated thoracentesis, the pleural effusion was persistent and intrathoracic infection was suspected. Surgical intervention was proposed and a preoperative endoscopic retrograde cholangiopancreatography revealed disruption of the mid pancreatic duct and a fistulous tract. A middle segment pancreatectomy was performed for removal of the disrupted portion of the main pancreatic duct and reconstruction of the distal pancreas was completed by end-to-side Rouxen-Y pancreatojejunostomy. The patient had a good postoperative course and was discharged on the 29th postoperative day. He has remained well during the 9 months of follow-up.
First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. s1-shiba@f3.dion.ne.jp
Shin-ichi
S
Shibasaki
Hiroyuki
H
Yamaguchi
Atsushi
A
Nanashima
Takashi
T
Tsuji
Masaaki
M
Jibiki
Terumitsu
T
Sawai
Toru
T
Yasutake
Tohru
T
Nakagoe
Hiroyoshi
H
Ayabe
D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000150:complications* / Q000601:surgery; D010193:Pancreaticojejunostomy; D010995:Pleural Diseases / Q000150:complications*; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery*; D016156:Respiratory Tract Fistula / Q000150:complications*