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Arch Hellen Med, 32(1), January-February 2015, 7-15


Pancreaticopleural fistula: From diagnosis to treatment

L. Vasilieva, D. Agiasotelli, S.P. Dourakis
Second Department of Internal Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece

Pancreaticopleural fistula is an uncommon but severe complication of acute, or more often chronic, pancreatitis, characterized by communication between the pleural cavity (usually the left side) and the pancreatic duct. Most patients are men, and are often alcoholics. Diagnosis is often delayed because of the predominance of respiratory symptoms and signs (dyspnea, cough, etc.). The diagnosis is made by the finding of increased amylase content in the pleural effusion. Magnetic resonance (MR) cholangiopancreatography is the best non-invasive procedure for establishing the diagnosis. The preferred treatment strategy consists of a combination of medical management with somatostatin analogues and endoscopic drainage with pancreatic sphincterotomy and plastic stent placement in the pancreatic duct, which, however, is not always feasible. The choice of management strategy in patients with pancreaticopleural fistula should be made early and is determined by the pancreatic ductal anatomy and the stenoses found on MR cholangiopancreatography. The most common complication of pancreaticopleural fistula is pleural empyema, which usually requires surgical treatment.

Key words: Chronic pancreatitis, Pancreatic sphincterotomy, Pancreaticopleural fistula.

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