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[Pleuro-pancreatic fistula diagnosed by ultrasonography]
1Unità Operativa Chirurgia II, AUSL 3 Piacenza.
Insights
Pancreaticopleural fistula, a rare condition causing pleural effusion, is increasingly recognized. Diagnosis relies on pleural fluid amylase and imaging, with surgery often resolving the effusion.
Area of Science:
- Gastroenterology
- Pulmonology
- Radiology
Background:
- Pancreaticopleural fistula is a rare cause of pleural effusion, characterized by an abnormal connection between the pancreas and the pleural space.
- This condition has seen increased recognition in the past decade, necessitating improved diagnostic and therapeutic strategies.
Observation:
- Elevated amylase levels in pleural fluid are a critical indicator for suspecting pancreaticopleural fistula.
- Imaging techniques including CT, MRI, ultrasound, and ERCP are essential for confirming the diagnosis and guiding treatment.
Findings:
- A case of pancreaticopleural fistula diagnosed via ultrasonography is presented, where CT and ERCP failed to visualize the fistula tract.
- Surgical intervention, specifically cysto-jejunostomy with a Roux-en-Y loop, successfully resolved the pleural effusion after conservative management failed.
Implications:
- This case highlights the diagnostic challenges and emphasizes the importance of considering pancreaticopleural fistula in unexplained pleural effusions.
- The findings underscore the efficacy of surgical management, particularly Roux-en-Y cysto-jejunostomy, for pancreatic pseudocysts complicated by pleural fistulas.
Abstract:
A pleural effusion resulting from pancreatitic-pleural fistula is a rare clinical entity which has, however, been more frequently recognised in the last ten years. The cause is a fistula tract between the pancreas and the pleura. Elevated amylase levels in the pleural fluid are the key to suspecting this diagnosis, which needs to be confirmed using imaging techniques such as CT, MRI and ultrasound or ERCP, which are necessary for defining the therapeutic strategy. After the failure of conservative management, a cysto-jejunostomy with a Roux-en-Y loop resolved the pleural effusion. This is the surgical technique of choice in the presence of a pseudocyst. We report details of a patient with a pancreaticopleural fistula diagnosed by ultrasonography, in which CT and ERCP were unable to demonstrate any communication between the pleural cavity and the pseudocyst. Only one similar case has been reported in the literature, diagnosed initially following visualization of a fistula tract at CT. We discuss the diagnostic and therapeutic options.