title: Pancreatico-pericardial fistula as a complication of chronic pancreatitis.
abstract: Pancreatico-pericardial fistula is an extremely rare complication of chronic pancreatitis. We present a case of a 58-year-old man who presented with syncope. Transthoracic echocardiogram revealed a pericardial effusion with tamponade physiology. Pericardiocentesis and pericardial fluid analysis demonstrated a lipase level of 2321 U/L. Subsequently, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, confirming the presence of a pancreatico-pericardial fistula (PPF) from the distal body of the pancreas. A pancreatic duct stent was placed across the duct disruption on two separate occasions; however, despite stent placement, the patient continued to re-accumulate pericardial fluid and deteriorated. While rare, PPFs may complicate chronic pancreatitis, may not respond to pancreatic duct stenting and may portend a poor prognosis.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, BDB 380, USA.
authors.forename: Camille Anne
authors.initials: CA
authors.lastname: Sommer
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, BDB 380, USA.
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox