Pancreatico-pleural fistula in chronic pancreatitis: A case report

Pancreatico-pleural fistula (PPF) is a rare and easily misdiagnosed complication of chronic pancreatitis, often presenting with respiratory symptoms and leading to significant diagnostic delays.

A 49-year-old male with chronic pancreatitis and alcohol abuse presented with a 6-month history of recurrent cough, sputum, and chest tightness, initially misdiagnosed as inflammatory pleural effusion.

PPF was confirmed by left pleural effusion with high amylase (9372 U/L), MRI/magnetic resonance cholangiopancreatography revealing a pancreatic pseudocyst and a fistula tract from the pancreatic tail to the left pleural cavity.

The patient underwent laparoscopic excision of the fistula tract, suture closure of the pancreatic end, and external drainage.

Postoperative drainage fluid amylase remained elevated (183,940 U/L), indicating persistent leakage. The patient was discharged with an abdominal drain. At 2-month follow-up, no effusion recurrence was observed.

PPF should be considered in patients with chronic pancreatitis and unexplained pleural effusion. Magnetic resonance cholangiopancreatography is effective for noninvasive diagnosis. Early surgical intervention is recommended if short-term medical management fails to prevent complications and reduce morbidity.