[Pancreatico-pleural fistula in chronic pancreatitis with necrosis of the pancreatic tail].
METHODS
A 68-year-old male was admitted to the hospital with progressive dyspnea and thoracic pain radiating to the shoulder, back and upper abdomen. The patients medical history included hypertension, diabetes and chronic pancreatitis with splenic vein thrombosis.


METHODS
Laboratory findings showed no signs of myocardial infarction, but pronounced inflammation. The ECG was normal. Chest X-ray revealed a massive left-side pleural effusion with partial lung atelectasis. An abdominal CT-scan showed no signs of acute pancreatitis. Puncture of the pleural effusion revealed elevated amylase and lipase. ERCP showed pancreatic duct stenosis, partial necrosis of the pancreatic body and peripancreatic necrosis with a pancreatico-pleural fistula.


METHODS
After ballon-dilatation of the constricted pancreatic duct, a plastic stent and a nasopancreatic drain were inserted into the necrosis and into the fistula. Drainage and antibiotic therapy led to regression of the necrosis within 3 weeks. With external pleural drainage and octreotide therapy almost complete regression of the pleural effusion and closure of the pancreatico-pleural fistula could be achieved within 3 weeks.


CONCLUSIONS
Complications of chronic pancreatitis such as necrosis and fistulas are rare, but important differential diagnoses in patients with chronic pancreatitis and chest pain. A combination of transpapillary or transgastral endoscopic drainage procedures and pleural drainage, sometimes with additional octreotide therapy is the treatment of choice.
Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig.
S
S
Neumann
K
K
Caca
J
J
Mössner
D000368:Aged; D000681:Amylases / Q000032:analysis; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002404:Catheterization; D002637:Chest Pain; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000150:complications / Q000628:therapy; D003937:Diagnosis, Differential; D004322:Drainage; D004417:Dyspnea; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008049:Lipase / Q000032:analysis; D008297:Male; D009336:Necrosis; D015282:Octreotide / Q000627:therapeutic use; D010179:Pancreas / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology*; D010183:Pancreatic Ducts / Q000473:pathology; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010195:Pancreatitis / Q000150:complications* / Q000473:pathology; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010996:Pleural Effusion / Q000201:enzymology / Q000209:etiology / Q000628:therapy; D011859:Radiography; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013162:Splenic Vein; D015607:Stents; D013927:Thrombosis / Q000150:complications
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D008049:Lipase; D000681:Amylases; D015282:Octreotide