Octreotide therapy for pancreaticopleural fistula.

Pancreaticopleural fistula is a rare but remediable complication of pancreatitis. Hitherto, treatment by means of total parenteral nutrition and thoracocentesis had resulted in an overall success rate of 40% only. Surgical obliteration of persistent fistulae is required in many cases, as the underlying pancreatic duct lesion often prevents spontaneous closure of the fistula. We report a patient suffering from pancreaticopleural fistula with a tightly strictured pancreatic duct. The fistula was successfully obliterated with the use of octreotide addition to thoracocentesis and total parenteral nutrition. Pancreatic bypass surgery was later performed only for pain relief. We believe that octreotide can effectively suppress pancreatic secretion and promote closure of pancreaticopleural fistula even in the presence of severe pancreatic duct lesions. Thus the risk of infection and early surgery for persistent fistula can be minimized.