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Published on: December 14, 2019
Pancreaticopleural fistula in children: Report of 2 cases
Tran Thanh Tri1,2, Pham Ngoc Thach1, Ho Phi Duy1
1Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam.
Insights
Pancreaticopleural fistula, a rare complication, often requires surgical intervention when conservative treatments fail. Surgical fistulo-jejunostomy offers an effective solution for pediatric patients with this condition.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Pediatric Surgery
Background:
- Pancreaticopleural fistula is an exceptionally rare complication arising from pancreatic duct injury.
- Current treatment strategies include conservative measures (e.g., pleural drainage) and interventional procedures (e.g., endoscopic retrograde cholangiopancreatography with sphincter stenting), yet no definitive consensus exists.
Observation:
- This study details two pediatric cases of pancreaticopleural fistula resulting from pancreatic trauma and pancreatitis.
- The primary symptom in both patients was dyspnea attributed to significant pleural effusion.
- Thoracoabdominal CT scans revealed extensive pleural effusions and direct fistulous tracts from the pancreatic duct into the thoracic cavity via the esophageal and aortic hiatuses.
Findings:
- Conservative management, including pleural drainage, proved ineffective in both pediatric cases.
- Surgical intervention, specifically fistulo-jejunostomy and cystojejunostomy, resulted in successful treatment for both patients.
- Patients demonstrated stable recovery and were discharged on postoperative days 10 and 12.
Implications:
- Conservative treatment for pancreaticopleural fistula frequently fails to resolve the condition.
- Surgical approaches like fistulo-jejunostomy and cystojejunostomy represent efficacious management strategies for refractory pancreaticopleural fistulas.
- This study highlights the importance of considering surgical intervention in pediatric cases where conservative measures are unsuccessful.
Abstract:
Pancreaticopleural fistula is an extremely rare complication of pancreatic duct injury. The reported treatments include conservative approaches, such as pleural drainage, and interventional approaches, such as sphincter stenting via endoscopic retrograde cholangiopancreatography and surgery. However, no specific consensus treatment has been defined. We present 2 cases of pediatric patients with pancreaticopleural fistulas due to pancreatic trauma and pancreatitis that were successfully treated surgically. The most prominent symptom in both cases was dyspnea caused by pleural effusion. Thoracoabdominal computed tomography scans showed large pleural effusions and visible fistulas from the pancreatic duct to the thoracic cavity through the esophageal hiatus and aortic hiatus. Following unsuccessful conservative treatment using pleural drainage, the 2 patients underwent surgical fistulo-jejunostomy and cystojejunostomy. Both patients were stable and were discharged on postoperative days 10 and 12. Conservative treatment for pancreaticopleural fistula often fails, and a surgical approach, such as fistulo-jejunostomy and cystojejunostomy, can serve as an efficacious management strategy when conservative treatment fails.
