scholarly journals Pancreaticopleural Fistula: Revisited

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Norman Oneil Machado
Keyword(s):  
Pleural Effusion ◽  
Pleural Cavity ◽  
Rare Complication ◽  
Operative Therapy ◽  
Clinical Suspicion ◽  
Endoscopic Retrograde ◽  
Endoscopic Retrograde Cholangiopancreaticography ◽  
Acute And Chronic Pancreatitis ◽  
Optimal Treatment Strategy ◽  
Present View

Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT. Endoscopic retrograde cholangiopancreaticography (ECRP) or magnetic resonance cholangiopancreaticography (MRCP) may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management. There is, however, a lack of clarity regarding the management, and the literature is reviewed here to assess the present view on its pathogenesis, investigations, and management.

scholarly journals Black pleural effusion: an unusual complication of pseudocyst pancreas

2021 ◽  
Vol 8 (7) ◽  
pp. 2238
Author(s):  
Spandana Jagannath ◽  
Ashok Kumar
Keyword(s):  
Pleural Effusion ◽  
Pancreatic Duct ◽  
Pancreatic Pseudocyst ◽  
Pleural Cavity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pancreatic Disease ◽  
Unusual Complication ◽  
Endoscopic Retrograde ◽  
Idiopathic Pancreatitis ◽  
Optimal Treatment Strategy

Pleural effusion following rupture of pancreatic pseudocyst into the pleural cavity resulting into pancreaticopleural fistula is an extremely uncommon complication of acute pancreatitis. Pancreaticopleural fistula also results from disruption of a major pancreatic duct usually due to an underlying pancreatic disease (chronic pancreatitis), trauma, or iatrogenic injury. Pleural effusion is predominantly left sided; however, right-sided and bilateral effusion occurs in 19% and 14% of patients respectively. The pleural effusate can be either serous, serosanguinous or black in colour. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like computed tomography (CT), endoscopic retrograde cholangiopancreatography (ECRP) or magnetic resonance cholangiopancreatography (MRCP) may establish the fistulous communication between the pancreas, pseudocyst and pleural cavity. The optimal treatment strategy has traditionally been medical management with thoracocentesis and/or tube thoracostomy and exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Surgery, in the current era, is considered in the event patient fails to respond to conservative management or the patient’s condition deteriorates. We report the case of a 24-years-old gentleman who was diagnosed with chronic idiopathic pancreatitis with pseudocyst who developed right sided black pleural effusion.

scholarly journals Pancreaticopleural fistula in a child with chronic pancreatitis harboring compound SPINK1 variants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Teera Kijmassuwan ◽  
Prapun Aanpreung ◽  
Varayu Prachayakul ◽  
Prakarn Tovichien
Keyword(s):  
Chronic Pancreatitis ◽  
Pleural Effusion ◽  
Pancreatic Duct ◽  
Imaging Modality ◽  
Rare Complication ◽  
Clinical Suspicion ◽  
High Index ◽  
Fistula Tract ◽  
Radiological Imaging ◽  
Pancreatic Duct Stent

Abstract Background Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis (CP) that requires a high index of clinical suspicion in the patient who presents with a pleural effusion. Visualizing the fistula tract from the pancreatic duct to the pleural space by radiological imaging provides confirmation of this complication. Case presentation A 9-year-old boy who presented with massive right pleural effusion secondary to PPF, a complication of CP from a genetic mutation involving two mutations of SPINK1. We successfully managed the case with by endoscopic pancreatic duct stent placement after failure of conservative treatment approaches. Conclusions PPF is a rare but serious complication of CP in all ages. The diagnosis of PPF in children requires a high index of clinical suspicion and should be considered in the differential diagnosis of massive pleural effusion where pancreatic pathology is present. A high level of pleural fluid amylase and the results from radiological imaging when the patients have symptoms play essential roles in the diagnosis of PPF. Currently, Magnetic resonance cholangiopancreatigraphy (MRCP) is the imaging modality of choice. Endoscopic therapy and surgery are treatment options for patients who do not respond to conservative therapy.

scholarly journals Urinothorax: A rare complication of spontaneous bladder rupture

2019 ◽  
Vol 6 (4) ◽  
pp. 16
Author(s):  
Cyrus Veryl Edelson ◽  
Scott Francis David Edelson ◽  
Jerome Craig Edelson ◽  
Guy S. Dooley
Keyword(s):  
Pleural Effusion ◽  
Alcohol Consumption ◽  
Adult Patient ◽  
Pleural Cavity ◽  
Rare Complication ◽  
Bladder Wall ◽  
Rare Condition ◽  
Autoimmune Disorders ◽  
Bladder Rupture ◽  
Spontaneous Bladder Rupture

Urinothorax (UT) is an uncommon cause of pleural effusion where urine collects in the pleural cavity that is usually caused by trauma or urinary obstruction. Spontaneous bladder rupture is another rare condition that is commonly caused by underlying bladder wall pathology and exacerbated by binge alcohol consumption, malignancy, autoimmune disorders, radiation, and obstructive or neurogenic pathology. We present a case of urinothorax caused by spontaneous bladder rupture in an adult patient successfully recognized and treated.

scholarly journals Splenic Injury Following Endoscopic Retrograde Cholangiopancreatography: A Case Report and Literature Review

2017 ◽  
Vol 11 (1) ◽  
pp. 241-249 ◽  
Author(s):  
Richard Lee ◽  
Alexander Huelsen ◽  
Nivene Saad ◽  
Peter Hodgkinson ◽  
Luke F. Hourigan
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Spanish Literature ◽  
Splenic Injury ◽  
Rare Complication ◽  
Treatment Options ◽  
Mirizzi Syndrome ◽  
Clinical Suspicion ◽  
Fatal Complication ◽  
Endoscopic Retrograde ◽  
The Past

Splenic injury following endoscopy is a rare but potentially fatal complication. While this has been found to occur more frequently after colonoscopy, splenic injury following endoscopic retrograde cholangiopancreatography (ERCP) remains highly uncommon since its first reported case in 1989. Indeed, there have been only 19 such cases reported in the English, German, and Spanish literature collectively over the past 27 years. We report on a 59-year-old woman who developed a peri-splenic haematoma diagnosed on abdominal computed tomography the day following ERCP and stenting for Mirizzi syndrome. The patient was treated conservatively and made a full recovery. We reviewed all cases of post-ERCP splenic injuries reported to date and discuss the published opinions on the likely mechanism of injury, predisposing factors, presenting features, investigation, and treatment options. Ultimately, patient outcome relies on clinical suspicion of this rare complication following ERCP.

scholarly journals Pancreatico‑pleural Fistula: Case Series

2018 ◽  
Vol 09 (01) ◽  
pp. 026-031 ◽  
Author(s):  
Manoj Munirathinam ◽  
Pugazhendhi Thangavelu ◽  
Ratnakar Kini
Keyword(s):  
Magnetic Resonance ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Case Series ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fluid Analysis ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis ◽  
Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

scholarly journals Granulomatous Hepatitis Following Intra-Vesical Instillation of Bacillus Calmette–Guérin for Treatment of Bladder Cancer

2021 ◽  
Vol 13 (3) ◽  
pp. 611-618
Author(s):  
Elsa Alves Branco ◽  
Raquel Duro ◽  
Teresa Brito ◽  
António Sarmento
Keyword(s):  
Bladder Cancer ◽  
Hepatitis A ◽  
Adverse Reactions ◽  
Superficial Bladder Cancer ◽  
Rare Complication ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Bacillus Calmette Guerin ◽  
Granulomatous Hepatitis ◽  
Appropriate Treatment

Intra-vesical instillation of bacillus Calmette–Guérin (BCG) is an important treatment modality of superficial bladder cancer. It is usually well tolerated, although some adverse reactions can occur. One possible yet rare complication is granulomatous hepatitis, that is thought to be caused either by BCG infection or a hypersensitivity reaction to the bacillus. We present a case of a 79-year-old apparently immunocompetent patient who developed granulomatous hepatitis a few months after BCG administration for bladder cancer immunotherapy. It is important to notice that acid-fast smears and cultures are often negative, and these should not exclude diagnosis nor delay treatment. Our case highlights the importance of clinical suspicion and prompt initiation of appropriate treatment.

scholarly journals Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koji Morishita ◽  
Hideaki Sasaki
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilatation ◽  
Rare Complication ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Balloon Dilatation ◽  
Cbd Stones ◽  
Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

scholarly journals Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110100
Author(s):  
Suqiao Yang ◽  
Jianfeng Wang ◽  
Jifeng Li ◽  
Kewu Huang ◽  
Yuanhua Yang
Keyword(s):  
Pleural Effusion ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Pulmonary Vein Stenosis ◽  
Pulmonary Artery Stenosis ◽  
Heart Catheterization ◽  
Tissue Mass ◽  
Fibrosing Mediastinitis ◽  
Extrinsic Compression ◽  
Left Pleural Effusion

Fibrosing mediastinitis (FM) is a progressive, life-threatening disease characterized by extrinsic compression of mediastinal bronchovascular structures, and the clinical manifestations largely depend upon the affected structures. Pleural effusion is rarely reported in patients with FM. We herein describe a 70-year-old man who presented with recurrent breathlessness and refractory left pleural effusion. He was misdiagnosed with and treated for tuberculous pleurisy for several months. Thoracentesis revealed a transudative pleural effusion, and a contrast-enhanced computed tomography scan of the thorax showed an extensive mediastinal soft tissue mass consistent with FM. Pulmonary angiography demonstrated pulmonary artery stenosis on the right side and pulmonary vein stenosis mainly on the left side. After measurement of the pulmonary arterial pressure by right heart catheterization, the patient was diagnosed with pulmonary hypertension associated with FM. He underwent balloon angioplasty and stent implantation of the stenosed pulmonary vessels, which led to long-term improvement in his breathlessness and pleural effusion. Our systematic review of the literature highlights that pleural effusion can be an uncommon complication of FM and requires careful etiological differentiation.

scholarly journals Sex-Related Differences of Acute and Chronic Pancreatitis in Adults

2021 ◽  
Vol 10 (2) ◽  
pp. 300
Author(s):  
Madeline Drake ◽  
Shah-Jahan M. Dodwad ◽  
Joy Davis ◽  
Lillian S. Kao ◽  
Yanna Cao ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
The United States ◽  
Prevention Strategies ◽  
Endoscopic Retrograde ◽  
Effective Prevention ◽  
Type 1 Autoimmune Pancreatitis ◽  
Acute And Chronic Pancreatitis ◽  
Effective Prevention Strategies

The incidence of acute and chronic pancreatitis is increasing in the United States. Rates of acute pancreatitis (AP) are similar in both sexes, but chronic pancreatitis (CP) is more common in males. When stratified by etiology, women have higher rates of gallstone AP, while men have higher rates of alcohol- and tobacco-related AP and CP, hypercalcemic AP, hypertriglyceridemic AP, malignancy-related AP, and type 1 autoimmune pancreatitis (AIP). No significant sex-related differences have been reported in medication-induced AP or type 2 AIP. Whether post-endoscopic retrograde cholangiopancreatography pancreatitis is sex-associated remains controversial. Animal models have demonstrated sex-related differences in the rates of induction and severity of AP, CP, and AIP. Animal and human studies have suggested that a combination of risk factor profiles, as well as genes, may be responsible for the observed differences. More investigation into the sex-related differences of AP and CP is desired in order to improve clinical management by developing effective prevention strategies, diagnostics, and therapeutics.

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