title: Pleuropancreatic fistulae: specialist center management.
abstract: OBJECTIVE
  Internal pancreatic fistulae are uncommon sequelae of severe acute pancreatitis. Due to their low prevalence, experience in the management of this condition remains sparse outside specialist centers and management remains controversial. We report our experience with pleuropancreatic fistulae (PPF).
  
  
  METHODS
  Six patients (three males, median age 34 years [range, 32-74 years]) with PPF were managed in our unit over a 24-month period from April 2006 to April 2008. The etiology of pancreatitis was alcohol (four), gallstones (one), and unknown cause (one). All patients had documented pleural effusions with amylase content >1,000 iu/dl.
  
  
  RESULTS
  All patients underwent computerized tomography (CT) and magnetic resonance imaging (MRI) cross-sectional scanning to identify the site of ductal disruption. CT alone was able to identify the disruption in four cases and a combination of CT and MRI localized the ductal disruption in all patients. Five of six patients required ERCP and placement of a pancreatic duct (PD) stent. No patient required pancreatic surgery and all patients remain well at a median follow up of 39 weeks.
  
  
  CONCLUSIONS
  Pleuropancreatic fistulae can present a challenging diagnostic dilemma. A multi-disciplinary approach addressing nutritional support and endotherapy allows successful non-operative resolution within specialist units.
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: A Z
authors.initials: AZ
authors.lastname: Khan
authors.forename: R
authors.initials: R
authors.lastname: Ching
authors.forename: G
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: R
authors.initials: R
authors.lastname: England
authors.forename: M B
authors.initials: MB
authors.lastname: Sherridan
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010995:Pleural Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed