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Bilateral Pleural Pancreatic Fistula: A Rare Case Report
Sanjay Gabhale1, Parna Chakraborty2, Brahmansh Singh2
1Department of Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Maharashtra, India.
Background:
Pancreatico-pleural fistula (PPF) is a rare complication of pancreatitis, with bilateral presentation being exceptionally uncommon. This case report describes the successful management of a bilateral PPF in a patient with alcohol-induced pancreatitis.
Case Presentation:
A 40-year-old male presented with epigastric pain and progressive breathlessness. Imaging revealed bilateral pleural effusions with pancreatic duct dilation and fistulous communication. Pleural fluid analysis showed markedly elevated amylase (6533 U/L) and lipase (31,319 U/L) levels. Management included bilateral chest tube drainage and endoscopic intervention with pancreatic duct stenting.
Results:
The patient showed significant improvement following the combination therapy of conservative management and endoscopic intervention. After 32 days of hospitalization, the patient was discharged with a pancreatic duct stent in situ and planned follow-up for repeat endoscopic retrograde cholangiopancreatography.
Conclusion:
This case highlights the importance of considering PPF in patients with unexplained pleural effusions and demonstrates the effectiveness of a multi-modal approach in managing bilateral pancreaticopleural fistulas.
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