Huerta OLD, Ramírez PII, Leonher RKL, Hermosillo SJM, Sandoval AJJ, Ramírez GLR

Language: Spanish
References: 11
Page: 38-42
PDF size: 363.53 Kb.

ABSTRACT

Introduction: Pancreaticopleural fistula is a disease of low incidence; it occurs in 0.4% of the patients with pancreatitis, most of them are males with alcoholic etiology. It occurs more frequently on the left side and dyspnea is the main presorting symptom. Diagnosis is established with Retrograde endoscopic cholangiopancreatography in 80% of the cases while bing therapeutic. Surgery is indicated when conservative or endoscopic treatment fails.
Case report: This is a forty-six year-old female admitted because of epigastric pain that radiates to the back along with nausea and vomiting. A diagnosis of Pancreatitis was established. Laparoscopic cholecystectomy was performed and three months later she presented dyspnea; chest X-ray and CT scan showed evidence of right pleural effusion, reporting elevated amylase (+20,000 U/L), endoscopic retrograde cholangiopancreatography was performed and pancreatic duct was not possible to cannulate. Magnetic resonance cholangiography was ordered which showed the fistulous tract. The patient underwent surgery and a cystojejunostomy was performed.
Discussion: Pancreaticopleural fistula is the accumulation high levels of amylase in the pleural space with secondary to disruption of the pancreatic duct; which can leak through the aortic of esophageal hiatus or by direct contact between the diaphragm and the pseudocyst. Left side involvement occurs in 76% of the cases. Diagnosis is suspected by fluid amylase elevated in the pleural space. Endoscopic retrograde cholangiopancreatography demonstrates the fistulous tract in 59-74%. Initial management should be conservative. Endoscopic therapy is effective in 25% of the cases. Surgical treatment is successful in 80-95%.

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