When Pancreas Pierces Pleura: An Uncommon Case of Pancreaticopleural Fistula Managed Endoscopically

Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis and typically presents with large recurrent pleural effusions. Herein, we present an unusually severe PPF in a 37-year-old woman with complete left lung atelectasis from a massive pleural effusion. Pleural fluid amylase exceeded 1500 U/L, and endoscopic retrograde cholangiopancreatography (ERCP) confirmed distal pancreatic duct disruption. The patient's course was complicated by a transdiaphragmatic pseudocyst, polymicrobial empyema, pulmonary abscess, and stent migration, requiring repeat ERCP and multiple drainage procedures. This case highlights the development of a rare thoracic complication, and demonstrates successful endoscopic management.