Format

Send to

Choose Destination
JOP. 2005 Mar 10;6(2):152-61.

Nonsurgical management of pancreaticopleural fistula.

Author information

1
Department of Surgery, 3rd Floor, Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom. adhebri@hotmail.com

Abstract

CONTEXT:

Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%.

AIM:

Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit.

METHODS:

Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE.

RESULTS:

Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases.

CONCLUSIONS:

A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.

PMID:
15767731
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for JOP. Journal of the Pancreas (Online)
Loading ...
Support Center