Pancreatico-pleural fistula in chronic pancreatitis: A case report.

RATIONALE: Pancreatico-pleural fistula (PPF) is a rare and easily misdiagnosed complication of chronic pancreatitis, often presenting with respiratory symptoms and leading to significant diagnostic delays.

PATIENT CONCERNS: A 49-year-old male with chronic pancreatitis and alcohol abuse presented with a 6-month history of recurrent cough, sputum, and chest tightness, initially misdiagnosed as inflammatory pleural effusion.

DIAGNOSES: PPF was confirmed by left pleural effusion with high amylase (9372 U/L), MRI/magnetic resonance cholangiopancreatography revealing a pancreatic pseudocyst and a fistula tract from the pancreatic tail to the left pleural cavity.

INTERVENTIONS: The patient underwent laparoscopic excision of the fistula tract, suture closure of the pancreatic end, and external drainage.

OUTCOMES: Postoperative drainage fluid amylase remained elevated (183,940 U/L), indicating persistent leakage. The patient was discharged with an abdominal drain. At 2-month follow-up, no effusion recurrence was observed.

LESSONS: PPF should be considered in patients with chronic pancreatitis and unexplained pleural effusion. Magnetic resonance cholangiopancreatography is effective for noninvasive diagnosis. Early surgical intervention is recommended if short-term medical management fails to prevent complications and reduce morbidity.