Pancreaticopleural fistula: a rare aetiology of pleural effusion

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis, which clinically presents as a pleural effusion and often with an absence of typical abdominal symptoms associated with pancreatic disease.We describe a man in his early 50s who presented to the emergency department with pleuritic chest pain and progressive breathlessness with a history of alcohol excess. Chest X-ray demonstrated a bilateral pleural effusion with a dark red amylase-rich exudate on needle aspiration, necessitating a chest drain insertion. CT imaging then highlighted a left-sided PPF. Multiple chest drain insertions were required throughout the patient's admission due to fluid reaccumulation.Endoscopic retrograde cholangiopancreatography (ERCP) was conducted to stent the primary pancreatic duct to prevent fluid leakage-which was unsuccessful, resulting in post-ERCP acute-on-chronic pancreatitis. On recovery, the patient was discharged with a right-sided chest drain (following fluid re-accumulation) with adequate outpatient follow-up-illustrating no further fluid accumulation 6 months later.