Pancreaticopleural fistula.

OBJECTIVES

Pancreaticopleural fistula (PPF) is an unusual complication of chronic pancreatitis. Its diagnosis is obscured by predominance of pulmonary symptoms. A review of clinical presentation, etiology, diagnostic, and treatment modalities is presented in context of 2 cases from our institution.

METHODS

Case reports and case series of PPFs in the English literature from 1960 to 2007 were identified in the PubMed, OVID, and EMBASE search engines.

RESULTS

Fifty-two cases of PPF were identified. Common presenting complaint was dyspnea (65%) followed by abdominal pain (29%), cough (27%) and chest pain (23%). Computed tomography scanning diagnosed PPF in 8 (47%) of 17 patients, endoscopic retrograde cholangiopancreatography diagnosed PPF in 25 (78%) of 32 patients, and magnetic resonance cholangiopancreatography diagnosed PPF in 8 (80%) of 10 patients. Twenty-one patients (65%) improved with conservative management alone. Interventional therapy (5 endoscopic and 6 surgical interventions) was eventually needed in 35% of the patients after failing conservative management.

CONCLUSIONS

Pancreaticopleural fistula is a rare finding and requires a high index of suspicion for patients presenting with chest symptoms or pleural effusion and with history of pancreatitis or alcoholism. Magnetic resonance cholangiopancreatography is the better initial choice for being a noninvasive procedure and for better demonstration of complete main pancreatic duct obstruction. Restoring anatomic continuity is important if conservative approach fails.