Cases reported "Pancreatic Fistula"

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1/40. Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography.

    Pancreaticopleural fistula secondary to chronic pancreatitis is a rare cause of recurrent pleural effusion. The demonstration of the fistula with endoscopic retrograde pancreatography and CT is invasive or limited. We report in two patients the use of magnetic resonance pancreatography as a noninvasive alternative to endoscopic retrograde pancreatography for the diagnosis of pancreaticopleural fistula.
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ranking = 1
keywords = effusion
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2/40. A case of eosinophilic pleural effusion induced by pancreatothoracic fistula.

    A 49-year-old man was admitted for evaluation of a left pleural effusion. Thoracenthesis yielded a hemorrhagic pleural effusion with a high percentage of eosinophils (15.9%). Although there were no significant abdominal signs, serological examinations demonstrated a marked increase of pancreatic enzyme activity. Moreover, abdominal CT demonstrated cystic changes between the tail of the pancreas and the spleen. Accordingly ERP was performed under pressure, and contrast medium draining from the pancreas was observed. Pancreatic pleural effusion in this patient consisted of pancreatic juice retained in the thoracic cavity, which resulted from intrapancreatic fistulation connecting to the thoracic cavity due to a pancreatic cyst caused by chronic pancreatitis. The present report indicates that we should investigate the retention of eosinophilic pleural effusion considering not only the possibility of thoracic disease, but also the possibility of a pleural effusion derived from abdominal diseases.
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ranking = 9
keywords = effusion
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3/40. Marked effect of octreotide acetate in a case of pancreatic pleural effusion.

    A pancreaticopleural effusion is a rare complication of chronic pancreatitis. fasting, a protease inhibitor, and/or a surgical intervention are generally selected for the treatment of the pancreatic effusion. We reported here the case, in which octreotide acetate was effective for resolving pancreatic effusion. A 67-year-old man was admitted with a massive pleural effusion. This effusion contained a high level of amylase. Endoscopic retrograde pancreatography followed by computed tomography revealed a pancreaticopleural fistula. The pleural effusion was not improved by the treatment of the protease inhibitor with total parenteral nutrition and fasting. A pancreatic stent could not be emplaced because the major pancreatic duct was coiled. Administration of octreotide acetate, a long-acting somatostatin analogue, markedly diminished the effusion and closed the pancreaticopleural fistula. Transient eosinophilia of peripheral blood was seen on admission, but the number of eosinophils decreased after the octreotide therapy and normalised when pleural effusion disappeared. octreotide is one of the effective options for the treatment of pancreatic pleural effusion.
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ranking = 13
keywords = effusion
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4/40. Sonographic demonstration of a pancreatopleural fistula.

    Pancreatopleural fistula is an uncommon complication of pancreatitis. The presence of a fistulous tract, although not mandatory for diagnosis of pancreatopleural fistula, has been documented previously with contrast-enhanced radiography and endoscopic retrograde cholangiopancreatography. We report the case of a pancreatopleural fistula with right pleural effusion demonstrated sonographically in a 13-year-old girl with a history of chronic pancreatitis and upper abdominal pain. Sonography also showed a pseudocyst of the pancreas with pleural effusion. The patient was treated conservatively with nutritional support and intercostal drainage of the pleural fluid. Her symptoms resolved and the pleural effusion gradually disappeared. Sonography is useful in confirming the presence of a suggested pancreatopleural fistula and can avoid the need for other, more technically challenging imaging modalities.
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ranking = 3
keywords = effusion
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5/40. Two cases of thoracopancreatic fistula in alcoholic pancreatitis: clinical and CT findings.

    We report two patients who were long-time habitual consumers of alcohol and suffered from thoracopancreatic fistula. The first patient, a 52-year-old man with no symptoms, underwent chest CT scan for a medical check-up and was revealed to have left small pleural effusion. A month later, he suddenly experienced severe cough and back pain. The immediate CT scan showed massive pleural effusion and mediastinal pseudocyst, and the amylase level in the aspirated pleural effusion proved to be elevated. He was successfully treated with medication and drainage of the effusion. The second patient, a 39-year-old woman, underwent CT scan for a medical check-up, and it disclosed that she had a small pleural effusion in the left lower thorax. Follow-up CT two months later revealed the pleural effusion to be resolved, however, it demonstrated that a narrow tract derived from the pancreatic secretion located just posterior to the pancreatic tail extended to the mediastinum along the left hemidiaphragmatic crus. She experienced severe cough and sputum four months later. CT scan showed massive pleural effusion in the left thorax and revealed that the pancreaticopleural fistula was located in the same position as the small tract that had been detected by the previous CT scan. The patient received conservative treatment and eventually recovered from the severe chest complications. We consider that asymptomatic left small pleural effusion in these patients who were habitual drinkers is a potential precursor to symptomatic pancreatitis. The patients developed mediastinal pseudocyst and pancreaticopleural fistula in association with chronic pancreatitis within a few months, and therefore intensive follow-up should be undertaken to minimize or prevent chest complications in association with the subsequent symptomatic pancreatitis.
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ranking = 8
keywords = effusion
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6/40. Pancreatic pleural effusion with a pancreaticopleural fistula diagnosed by magnetic resonance cholangiopancreatography and cured by somatostatin analogue treatment.

    A 69-year-old man with chronic alcoholic pancreatitis developed a left-sided massive pleural effusion. Magnetic resonance cholangiopancreatography clearly demonstrated the pancreatic cyst and the fistula connecting the cyst with the left pleural cavity, resulting in the diagnosis of pancreatic pleural effusion with a pancreaticopleural fistula. Conservative somatostatin analogue treatment completely eradicated the pancreatic pleural effusion and closed the pancreaticopleural fistula.
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ranking = 7
keywords = effusion
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7/40. Surgical treatment for right pleural effusions caused by pancreaticopleural fistula.

    A 56-year-old man with a history of alcohol abuse presented with exertional dyspnea. A chest radiography showed a massive right pleural effusion with sanguineous pleural fluid and an amylase level of 97,188 IU/L. Despite conservative treatment with no oral intake, total parenteral nutrition and repeated thoracentesis, the pleural effusion was persistent and intrathoracic infection was suspected. Surgical intervention was proposed and a preoperative endoscopic retrograde cholangiopancreatography revealed disruption of the mid pancreatic duct and a fistulous tract. A middle segment pancreatectomy was performed for removal of the disrupted portion of the main pancreatic duct and reconstruction of the distal pancreas was completed by end-to-side Rouxen-Y pancreatojejunostomy. The patient had a good postoperative course and was discharged on the 29th postoperative day. He has remained well during the 9 months of follow-up.
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ranking = 6
keywords = effusion
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8/40. Pancreatico-pericardial fistula: a rare complication of chronic pancreatitis.

    A 16-year-old boy presented with pericardial effusion, bilateral pleural effusion and mediastinal fluid collection. CT scan of abdomen revealed pancreatic calcification and a fistulous tract from a pseudocyst going along the inferior vena cava wall up to the pericardial cavity. After initial pericardiocentesis and pleurocentesis, lateral pancreatico-jejunostomy with Roux-en-Y loop was performed. The patient is well at 6 months follow up.
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ranking = 2
keywords = effusion
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9/40. Nonsurgical management of pancreaticopleural fistula.

    CONTEXT: Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. AIM: Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. methods: patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in medline and EMBASE. RESULTS: Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. CONCLUSIONS: A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.
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ranking = 1
keywords = effusion
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10/40. Internal pancreatic fistula in a child with pancreas divisum: An unusual manifestation of an uncommon anomaly.

    OBJECTIVES: Report of an unusual case of pancreatic fistula in a child. BACKGROUND: pancreatic diseases are relatively uncommon in the pediatric age group, with a rather heterogeneous clinical picture from generic abdominal distension to massive pleural effusion. CLINICAL RELEVANCE: The amylase analysis of pleural liquid is crucial for the etiologic diagnosis of pancreatitis with internal pancreatic fistula. Magnetic resonance cholangiopancreatography may support the etiologic diagnosis of pancreatic pleural fistula in children. Management of internal pancreatic fistula is analyzed. CONCLUSION: Maintaining a high index of suspicion is essential for the etiologic diagnosis of pancreatic pleural fistula in children.
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ranking = 1
keywords = effusion
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