Pancreatopleural fistula in childhood

A boy in late childhood presented with recurrent right-sided pleural effusions, chest pain and respiratory distress, which temporarily improved after aspiration. The pleural fluid was consistently dark red. Due to repeated effusions, a right intercostal drain was placed. History revealed recent abdominal trauma from a bicycle handle. A CT scan of the chest showed right patchy consolidation, hydropneumothorax and a multiloculated hypodense collection tracking from the right paraesophageal region to the tail of the pancreas. Both serum and pleural fluid amylase and lipase were elevated. Magnetic resonance cholangiopancreatography confirmed bilateral (right greater than left) pancreatopleural fistulas. The patient was treated with nil per oral status, total parenteral nutrition and Octreotide. Over a period of 10 days, drainage decreased, the chest tube was removed, and the child was discharged.