Pancreaticopleural Fistula

Pancreaticopleural Fistula - Case Study:

A 15 year old boy was brought to us with confirmed chronic pancreatitis of unknown cause. Patient was suffering from recurrent abdominal pain, was unable to eat well and was not able to show the growth spurt seen at his age. We again ruled out all standard causes of pancreatitis. Only genetic tests were kept on hold as they would not change treatment in him. He had classic dilated pancreatic duct with calculi in it all along from head to tail. He was scheduled for surgery.

The time gap between his MRCP and admission for surgery was of 15 days. Investigations on admission like X ray chest and CT scan showed large fluid collection around right lung occupying almost entire right thorax with collapse of right lung. The most likely source looked like a leaking pancreatic duct with the pancreatic juice finding a way to the right chest cavity. This is known as pancreaticopleural fistula. The fluid was aspirated under ultrasonography guidance for tests, which confirmed our suspicion.

The treatment plan needed a change now and patient was subjected to a minor surgery as 1st step whereby a drainage tube was inserted in the right chest and around 4 L fluid was drained out. As a result lung expanded significantly but the tube was not enough to prevent refilling.

Patient was taken up for final surgery after 4 days. In the 1st part a thoracoscopic lavage of right chest cavity was done and 2 tubes were inserted. This was followed immediately by the main abdominal surgery where in the pancreatic duct was opened and all the stones were removed. The pancreatic head coring was done and pancreas was joined to intestine.

Patient recovered well from both thoracic and abdominal surgery and was discharged after 10 days. He is now symptom free and doing well.