title: Pancreaticopleural fistula: etiology, treatment and long-term follow-up.
abstract: BACKGROUND
  Pancreaticopleural fistula (PPF) are uncommon. Complex multidisciplinary treatment is required due to nutritional compromise and sepsis. This is the first description of long-term follow-up of patients with PPF.
  
  
  METHODS
  Eleven patients with PPF treated at a specialist unit were identified. Causation, investigation, treatment and outcomes were recorded.
  
  
  RESULTS
  Pancreatitis was the etiology of the PPF in 9 patients, and in the remaining 2 the PPF developed following distal pancreatectomy. Cross-sectional imaging demonstrated the site of duct disruption in 10 cases, with endoscopic retrograde cholangiopancreatography identifying the final case. Suppression of pancreatic exocrine secretion and percutaneous drainage formed the mainstay of treatment.Five cases resolved following pancreatic duct stent insertion and three patients required surgical treatment for established empyema. There were no complications. In all cases that resolved there has been no recurrence of PPF over a median follow-up of 50 months (range 15-62).
  
  
  CONCLUSIONS
  PPF is an uncommon event complicating pancreatitis or pancreatectomy; pancreatic duct disruption is the common link. A step-up approach consisting of minimally invasive techniques treats the majority with surgery needed for refractory sepsis.
authors.affiliation: Department of Pancreatic Surgery, St James University Hospital, Leeds, UK. j.k.roberts@bham.ac.uk
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: Maria
authors.initials: M
authors.lastname: Sheridan
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology* / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications*; D010995:Pleural Diseases / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D018805:Sepsis / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome