title: Role of diaphragm in pancreaticopleural fistula.
abstract: A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.
authors: Anestis P
authors: AP
authors: Ninos
authors: Stephanos K
authors: SK
authors: Pierrakakis
mesh_terms: D006801:Humans; D008297:Male; D010185:Pancreatic Fistula / Q000150:complications*; D010996:Pleural Effusion / Q000209:etiology*; D011183:Postoperative Complications; D013156:Splenectomy / Q000009:adverse effects*