Pancreaticopleural fistula.
OBJECTIVE
Pancreaticopleural fistula (PPF) is an unusual complication of chronic pancreatitis. Its diagnosis is obscured by predominance of pulmonary symptoms. A review of clinical presentation, etiology, diagnostic, and treatment modalities is presented in context of 2 cases from our institution.


METHODS
Case reports and case series of PPFs in the English literature from 1960 to 2007 were identified in the PubMed, OVID, and EMBASE search engines.


RESULTS
Fifty-two cases of PPF were identified. Common presenting complaint was dyspnea (65%) followed by abdominal pain (29%), cough (27%) and chest pain (23%). Computed tomography scanning diagnosed PPF in 8 (47%) of 17 patients, endoscopic retrograde cholangiopancreatography diagnosed PPF in 25 (78%) of 32 patients, and magnetic resonance cholangiopancreatography diagnosed PPF in 8 (80%) of 10 patients. Twenty-one patients (65%) improved with conservative management alone. Interventional therapy (5 endoscopic and 6 surgical interventions) was eventually needed in 35% of the patients after failing conservative management.


CONCLUSIONS
Pancreaticopleural fistula is a rare finding and requires a high index of suspicion for patients presenting with chest symptoms or pleural effusion and with history of pancreatitis or alcoholism. Magnetic resonance cholangiopancreatography is the better initial choice for being a noninvasive procedure and for better demonstration of complete main pancreatic duct obstruction. Restoring anatomic continuity is important if conservative approach fails.
Ali
Tauseef
T
Departments of Internal Medicine-Section of Digestive Disease, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73013, USA. Tauseef-ali@ouhsc.edu
Srinivasan
Nandakumar
N
Le
Vu
V
Chimpiri
A Rao
AR
Tierney
William M
WM
D015746:Abdominal Pain / Q000209:etiology / Q000473:pathology; D000328:Adult; D002637:Chest Pain / Q000209:etiology / Q000473:pathology; D015505:Chest Tubes; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003131:Combined Modality Therapy; D003371:Cough / Q000209:etiology / Q000473:pathology; D004417:Dyspnea / Q000209:etiology / Q000473:pathology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000473:pathology / Q000628:therapy; D010288:Parenteral Nutrition; D010995:Pleural Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010996:Pleural Effusion / Q000209:etiology / Q000473:pathology; D012008:Recurrence; D016156:Respiratory Tract Fistula / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005765:Gastrointestinal Agents