Introduction
Pleuropancreatic fistula (PPF), a rare complication of pancreatic disease, typically arises from pancreatic duct disruption, causing amylase-rich pleural effusions. While conservative management is often tried, endoscopic pancreatic duct stenting is vital for promoting fistula closure. This case report highlights the successful resolution of a PPF after endoscopic stent placement.
Case Presentation
A 55-year-old male presented with progressive dyspnea and left-sided pleuritic chest pain. He had a history of alcohol-related abdominal pain and insulin-controlled diabetes. Ten days prior, he developed dyspnea. A chest X-ray showed a large left pleural effusion, initially drained via a chest tube. Pleural fluid analysis revealed markedly elevated amylase (60,640 IU/L), with serum amylase also high (1,925 IU/L). The effusion persisted despite chest tube drainage.
Once stable, an ERCP was performed. Interestingly, CT and ERCP did not clearly show a communication between the pancreatic duct and the pleural cavity, nor was there clear evidence of duct disruption. However, given the extremely high pleural amylase, a plastic pancreatic stent was successfully placed in the body of the pancreatic duct. Afterward, the left pleural effusion resolved.
Discussion
The patient's symptoms and pleural effusion gradually improved following stent placement. This case underscores the efficacy of endoscopic pancreatic stenting as a minimally invasive and effective treatment for PPFs. It achieved this by decompressing the pancreatic duct, even when duct disruption wasn't clearly visualized—a key finding.
Conclusion
Though uncommon, consider PPF in patients with unexplained amylase-rich pleural effusions and a history of pancreatic issues. Endoscopic pancreatic stent placement offers a safe and successful treatment, resolving the fistula and preventing further complications. This case supports endoscopic management as a first-line treatment for PPF.