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Pancreaticopleural fistula: etiology, treatment and long-term follow-up

Keith J Roberts1, Maria Sheridan, Gareth Morris-Stiff

  • 1Department of Pancreatic Surgery, St James University Hospital, Leeds, UK. j.k.roberts@bham.ac.uk

Hepatobiliary & Pancreatic Diseases International : HBPD INT
|April 10, 2012
PubMed

Insights

Pancreaticopleural fistula (PPF) is rare, often stemming from pancreatitis or pancreatectomy. Minimally invasive treatments, including stent insertion, effectively manage most cases, preventing recurrence over long-term follow-up.

Area of Science:

  • Gastroenterology
  • Thoracic Surgery
  • Interventional Radiology

Background:

  • Pancreaticopleural fistula (PPF) is an uncommon complication.
  • Patients often experience nutritional compromise and sepsis.
  • Long-term follow-up data for PPF is limited.

Purpose of the Study:

  • To describe the long-term outcomes of patients with pancreaticopleural fistula.
  • To analyze the etiology, investigation, and treatment of PPF.
  • To establish the efficacy of a step-up treatment approach.

Main Methods:

  • Retrospective review of 11 patients with PPF treated at a specialist center.
  • Analysis of causation, diagnostic imaging, and therapeutic interventions.
  • Assessment of treatment outcomes and recurrence rates during long-term follow-up.

Main Results:

  • Pancreatitis (9 cases) and distal pancreatectomy (2 cases) were the primary causes of PPF.
  • Cross-sectional imaging and ERCP identified duct disruption.
  • Minimally invasive treatments, including pancreatic duct stenting and percutaneous drainage, were successful in most cases.
  • Surgical intervention was required for refractory empyema in three patients.
  • No recurrence of PPF was observed in resolved cases over a median follow-up of 50 months.

Conclusions:

  • Pancreatic duct disruption is the common link in PPF, regardless of etiology.
  • A step-up approach utilizing minimally invasive techniques is effective for managing PPF.
  • Surgery is reserved for refractory sepsis cases, with good long-term outcomes reported.
Abstract

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