scholarly journals Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

2021 ◽  
Author(s):  
Ayah Megahed ◽  
Rahul Hegde ◽  
Pranav Sharma ◽  
Rahmat Ali ◽  
Anas Bamashmos
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pleural Fluid ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

scholarly journals Pancreatico-pericardial fistula as a complication of chronic pancreatitis

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 31 ◽  
Author(s):  
Camille Anne Sommer ◽  
C. Mel Wilcox
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Poor Prognosis ◽  
Rare Complication ◽  
Pericardial Fluid ◽  
Endoscopic Retrograde ◽  
Fluid Analysis ◽  
Pancreatic Duct Stent ◽  
Pancreatic Duct Stenting ◽  
Duct Disruption

Pancreatico-pericardial fistula is an extremely rare complication of chronic pancreatitis. We present a case of a 58-year-old man who presented with syncope. Transthoracic echocardiogram revealed a pericardial effusion with tamponade physiology. Pericardiocentesis and pericardial fluid analysis demonstrated a lipase level of 2321 U/L. Subsequently, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, confirming the presence of a pancreatico-pericardial fistula (PPF) from the distal body of the pancreas. A pancreatic duct stent was placed across the duct disruption on two separate occasions; however, despite stent placement, the patient continued to re-accumulate pericardial fluid and deteriorated. While rare, PPFs may complicate chronic pancreatitis, may not respond to pancreatic duct stenting and may portend a poor prognosis.

scholarly journals Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

2022 ◽  
pp. 547-549
Author(s):  
Mohd Monis ◽  
Md Khalaf Saba ◽  
Syed M Danish Qaseem ◽  
Nadeem Arshad
Keyword(s):  
Pleural Fluid ◽  
Rare Case ◽  
Rare Complication ◽  
Necrotizing Pancreatitis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fistula Formation ◽  
Direct Visualization ◽  
Pleural Effusions ◽  
Fluid Analysis ◽  
Progressive Dyspnea

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

scholarly journals Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

2021 ◽  
Vol 28 (3) ◽  
pp. 144-154
Author(s):  
V. M. Durleshter ◽  
A. V. Makarenko ◽  
A. Yu. Bukhtoyarov ◽  
D. S. Kirakosyan
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Splenic Artery ◽  
Clinical Case ◽  
Pancreatic Pseudocyst ◽  
Rare Complication ◽  
Gastrointestinal Haemorrhage ◽  
Artery Pseudoaneurysm ◽  
Pancreatic Duct Stenting ◽  
Splenic Artery Pseudoaneurysm

Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.

Narcotic Independence After Pancreatic Duct Stenting Predicts Narcotic Independence After Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Pancreas ◽  
2016 ◽  
Vol 45 (8) ◽  
pp. 1126-1130 ◽  
Author(s):  
Richard S. Kwon ◽  
Benjamin E. Young ◽  
William F. Marsteller ◽  
Christopher Lawrence ◽  
Bechien U. Wu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Pancreatic Duct Stenting

scholarly journals Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

2019 ◽  
Vol 36 (04) ◽  
pp. 279-285
Author(s):  
Mythraeyee Prasad ◽  
Sipra Rout ◽  
Tharani Putta ◽  
Reuben Thomas Kurien ◽  
Sudipta Dhar Chowdhury ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Magnetic Resonance ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Radiological Study ◽  
Ductal System ◽  
Type Iii ◽  
Ansa Pancreatica

Abstract Introduction Morphological variants of the pancreatobiliary system can predispose to chronic pancreatitis. The goal of the present study is to assess the prevalence of pancreatic duct patterns in the Indian population, both by cadaveric dissection and by magnetic resonance cholangiopancreatography (MRCP). Materials and Methods A total of 15 adult pancreas specimens of unknown age and gender, and 5 fetal pancreas specimens of different gestational ages with the intact second part of duodenum, were dissected by the piecemeal method. For clinical relevance, MRCP images of 103 clinically-diagnosed chronic pancreatitis patients irrespective of their etiology were obtained retrospectively from the existing database and studied. The anatomical patterns were classified as five different types based on the course of the main pancreatic duct and the accessory pancreatic duct and their openings into the duodenal wall, including variants like pancreas divisum and ansa pancreatica. Results In the cadaveric study, the main pancreatic duct was single with a straight course in 46.67% of the adult specimens, and in the MRCP study, the main pancreatic duct showed a descending course in 77.66% of the cases. The most common pattern was type III in both the cadaveric (80%) and radiological (55.33%) studies, and the accessory duct was absent on the MRCP in all type-III cases, while it ended blindly in the cadaveric specimens. Ansa pancreatica (type V) was observed in 1 adult specimen (6.7%), but not in the radiological study. Pancreas divisum (type IV) was observed in the 8 cases (7.76%) cases in the radiological study. Conclusion Knowledge of the anatomical variants of the pancreatic ductal system may be helpful for the radiologists during diagnostic and therapeutic interventional procedures.

Pancreatic Duct Stenting for Painful Chronic Pancreatitis: Does Size Matter in Preventing Hospitalization?

2008 ◽  
Vol 67 (5) ◽  
pp. AB327
Author(s):  
Bryan Sauer ◽  
Vanessa M. Shami ◽  
Jennifer Ku ◽  
Kristi Ellen ◽  
Michel Kahaleh
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pancreatic Duct Stenting ◽  
Size Matter

scholarly journals Subdural Hematoma Following Spinal Cord Stimulator Implant

2008 ◽  
Vol 1;11 (1;1) ◽  
pp. 97-101
Author(s):  
Srinivas Chiravuri
Keyword(s):  
Spinal Cord ◽  
Subdural Hematoma ◽  
Dural Puncture ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Secondary Process ◽  
Spinal Cord Stimulator ◽  
Diagnostic Challenge ◽  
Treatment Change ◽  
Presenting Symptoms

Headache following interventional procedures is a diagnostic challenge due to the multitude of possible etiologies involved. Presentation can be simple (PDPH alone) or complex (exacerbation of pre-existing chronic headache along with PDPH) or headache associated with a new onset intracranial process. Subdural hematoma is a rare complication of cranio-spinal trauma. Cranial subdural hematoma may present in an acute, sub-acute, or chronic fashion. Diagnosis of a subdural hematoma in the wake of a PDPH is difficult, requiring a high level of suspicion. Delayed diagnosis of subdural hematoma is usually related to failure to consider it in the differential diagnosis. Thorough history, assessment of the evolution of symptoms, and imaging studies may identify the possible cause and help direct treatment. Change in the character of initial presenting symptoms may be a sign of resolution of the headache or the onset of a secondary process. We report a case of acute intracranial subdural hematoma secondary to unintentional dural puncture during placement of a permanent spinal cord stimulator lead for refractory angina. There is need for careful follow-up of patients with a known post-dural tear. Failure to identify uncommon adverse events in patients with complicated spinal cord stimulator implantation may lead to permanent injury. Key words: Subdural, post-dural puncture, headache, spinal cord stimulation

scholarly journals Gastrointestinal Hemorrhage Due to Splenic Artery Aneurysm Pancreatic Duct Fistula in Chronic Pancreatitis

HPB Surgery ◽  
1993 ◽  
Vol 7 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Christian Seiler ◽  
Leslie H. Blumgart
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Gastrointestinal Hemorrhage ◽  
Splenic Artery ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Artery Aneurysm ◽  
Splenic Artery Aneurysm ◽  
Life Threatening ◽  
Threatening Situation

Gastrointestinal hemorrhage due to splenic artery aneurysm pancreatic duct fistula in chronic pancreatitis is rare. It is, however, important to diagnose this condition particularly in patients having chronic pancreatitis, since it may result in a life-threatening situation. The diagnosis is usually difficult to establish and it may take repeated admissions for intermittent gastrointestinal bleeding until the real source is recognized. Clinical attacks of epigastric pain followed by GI-bleeding 30–40 minutes later are characteristic. Occasionally these attacks are followed by transient jaundice. The present case report describes this rare complication and reviews the current literature.

scholarly journals Pancreaticopleural fistula: a case report

2018 ◽  
Vol 8 (3) ◽  
pp. 73-75
Author(s):  
Bikas Thapa ◽  
Nirajan Subedi ◽  
Ramesh S. Bhandari
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Chronic Pancreatitis ◽  
Fistulous Tract ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Space ◽  
Diagnostic Challenge ◽  
Endoscopic Retrograde ◽  
Chronic Alcoholic ◽  
Surgical Interventions

Pancreaticopleural fistula is a diagnostic challenge to physicians. The diagnosis should be suspected if a patient presents with pleural effusion in a setting of chronic pancreatitis. The significantly raised amylase in the pleural fluid offers an important clue to the diagnosis. Computed Tomography (CT), Endoscopic retrograde cholangiopancreatography (ERCP) and Magnetic resonance cholangiopancreatography (MRCP) can reveal the fistulous tract between the pancreas and the pleural space. The therapeutic options include medical, endoscopic, as well as surgical interventions. Here we report a case of pancreaticopleural fistula in a chronic alcoholic that was treated successfully by medical management.

scholarly journals Talcoma: A Diagnostic Challenge in Differential Diagnosis of Pleural Masses

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Iclal Ocak ◽  
Rohit Dewan
Keyword(s):  
Differential Diagnosis ◽  
Present Report ◽  
Rare Complication ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Talc Pleurodesis

Talcoma is a pleural mass which may develop as a rare complication following talc pleurodesis. Talc pleurodesis is performed to obliterate the pleural space to prevent recurrent pleural effusions or persistent pneumothoraces. The present report describes a case of a patient who developed enlarging pleural mass (talcoma) following talc pleurodesis.

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