Pancreaticopleural fistula in a child with chronic pancreatitis harboring compound SPINK1 variants
Teera Kijmassuwan1, Prapun Aanpreung2, Varayu Prachayakul3
1Division of Gastroenterology, Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand. teera.kij@mahidol.edu.
Insights
Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis. This case highlights successful endoscopic stent management for a child with PPF, emphasizing early diagnosis and intervention.
Area of Science:
- Gastroenterology
- Pulmonology
- Pediatric Medicine
Background:
- Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis (CP).
- Diagnosis requires high clinical suspicion in patients with unexplained pleural effusion.
- Radiological imaging is crucial for confirming the fistula tract.
Observation:
- A 9-year-old boy with massive right pleural effusion due to PPF, secondary to CP with SPINK1 mutations.
- Conservative treatments failed.
Findings:
- Successful management of pediatric PPF using endoscopic pancreatic duct stent placement.
- High pleural fluid amylase and MRCP are key diagnostic tools.
- Endoscopic therapy is effective after conservative treatment failure.
Implications:
- PPF is a serious complication across all age groups.
- Early diagnosis in children with pancreatic pathology and pleural effusion is vital.
- Endoscopic therapy offers a viable treatment option for refractory PPF.
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.
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