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Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess
03:42

Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess

Published on: March 15, 2024

[Recurrent massive bloody pleural effusion caused by pancreatic pleural fistula in a case]

Hui-min Li1, Shun-ying Zhao, Jin Zhou

  • 1Department of Pediatric Internal Medicine, Beijing Children's Hospital Affiliated to Capital Medical University, Be4iing 100045, China.

Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics
|December 3, 2009
PubMed

Insights

Pediatric pancreatic pleural fistula often presents with respiratory symptoms and bloody pleural effusion. Elevated amylase in pleural fluid is a key diagnostic clue, guiding treatment with ERCP if conservative measures fail.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Pulmonology

Background:

  • Pancreatic pleural fistula is a rare condition where a connection forms between the pancreas and the pleural space.
  • Early diagnosis and treatment are crucial, but often delayed due to non-specific initial symptoms.

Observation:

  • A 4-year-old boy presented with a month of fever, cough, and chest pain, exhibiting massive bloody pleural effusion.
  • Initial abdominal examination was unremarkable, but pancreatic echo was abnormal on ultrasound.
  • Significantly elevated amylase levels were found in both blood (495 U/L) and pleural fluid (35,938 U/L).

Findings:

  • Thoracic surgical exploration revealed a fistulous tract connecting the thoracic cavity to the pancreas.
  • The child was successfully treated with total parenteral nutrition, somatostatin infusion, and endoscopic retrograde cholangiopancreatography (ERCP)-guided pancreatic duct stenting.

Implications:

  • Respiratory symptoms and bloody pleural effusion in children can indicate pancreatic pleural fistula.
  • High amylase levels in pleural fluid are a critical diagnostic marker.
  • ERCP is a valuable tool for both diagnosis and treatment when conservative management is insufficient.
Abstract

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