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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2004 December;17(6):237-42
Pancreaticopleural fistula. Endoscopic treatment by endoprosthesis stenting the Wirsung duct
Calati A. M., Rubis Passoni G., Meda S., Schubert L.
The authors report the case of a 56-year-old man with a history of symptomatic atherosclerosis, chronic alcoholic pancreatitis (2 episodes) and laparotomic surgical approach for pseudocysto-gastrostomy 4 years before. Physical examination revealed at first a left-sided pleural effusion and subsequently a right-sided one. The patient was admitted in another Hospital where, careless for his history, he underwent many examinations and also videothoracoscopic pleural biopsy, without reaching a final diagnosis. Having failed also to respond to medical treatment, he was transferred to our Hospital. Pleural fluid amylase measurement, after a thoracentesis for a new episode of left-sided pleural effusion, permitted us to diagnose a pancreaticopleural fistula. CT images of the thorax and upper abdomen, endoscopic ultrasonography and endoscopic retrograde pancreatography were performed. This latter examination permitted to stent the Wirsung duct with an endoprosthesis, stopping the supply of the fistula by repairing the duct disruption. The evolution after 1 year is still uneventful. This is a rare disease: about 100 cases in the literature. Some characteristics are common in all the cases reported: history of pancreatic chronic/recurrent disease; alcoholism; chest symptoms alone; differential diagnosis with malignant thoracic neoplasms. In order to establish the diagnosis, it is sufficient to perform a pleural fluid amylase measurement. Abdominal and thoracic CT, endoscopic ultrasonography and endoscopic retrograde pancreatography are subsequently helpful; this latter one allows a therapeutic approach (pancreatic stent) that in our case was particularly appropriate and successful. A 12-month follow-up is appreciable, considering the rarity of the disease and the use of a new medical treatment.