Pancreaticobronchial fistula associated with chronic pancreatitis: report of a case

Successful treatment of mediastinal pancreatic pseudocyst and pancreatic pleural effusion with endoscopic pancreatic duct drainage: A case report

An 81‐year‐old man with chronic pancreatitis was being treated with a protease inhibitor. He developed an acute exacerbation of chronic pancreatitis and dyspnea. Contrast‐enhanced computed tomography showed disruption of the main pancreatic duct, a cystic lesion connecting the mediastinum to the main pancreatic duct, and left pleural effusion. We diagnosed a pancreatic pseudocyst, mediastinal pancreatic pseudocyst, and pancreatic pleural effusion. Endoscopic retrograde pancreatography showed leakage of contrast medium from the pancreatic body; furthermore, a cystic cavity extending to the mediastinum through a pancreatic duct fistula was visualized. An endoscopic transpapillary nasopancreatic drainage tube was placed in the cystic cavity. Computed tomography showed that the mediastinal pseudocyst and pleural effusion had disappeared. Endoscopic transpapillary pancreatic duct drainage may be useful when a connection between the main pancreatic duct and a mediastinal pseudocyst is confirmed by imaging.

Pancreatic Fistula Extending into the Thigh Caused by the Rupture of an Intraductal Papillary Mucinous Adenoma of the Pancreas

We herein report the first case of a pancreatic fistula extending into the thigh caused by the rupture of an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. An 80-year-old man was suspected to have necrotizing fasciitis because of right femoral pain. Computed tomography showed fluid retention from the pancreatic head to the right iliopsoas muscle and an IPMN at the pancreatic head. The findings of endoscopic retrograde pancreatography led to the suspicion of a minor leak and a pancreatic stent was placed. The patient died due to an uncontrollable infection. A pathological autopsy showed a pancreatic fistula extending into the thigh that had been caused by the rupture of the IPMN.

Pancreaticobronchial Fistula Diagnosed by MDCT

Pancreatic duct disruption is a serious complication of acute or chronic pancreatitis. These ruptures may cause collections of pancreatic secretion leading to ascites but also to pleural or mediastinal effusions. Rupture into the bronchial tree, resulting in a pancreaticobronchial fistula, is also possible, but it is a rare complication. It should be considered if a patient with pancreatitis develops respiratory symptoms and requires cross-sectional imaging to identify pancreaticobronchial fistulae.

An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings

Fluid collections are common findings of pancreatitis and spread, more often, along preferential drainage pathways in the abdomen. In some rare cases, fluid collections may spread towards extra-abdominal sites like the mediastinum leading to the formation of mediastinal collections. We present the case of a 52-years-old man with pain in the right upper quadrant of the abdomen and mid-epigastrium lasting for some hours. Laboratory tests suggested a diagnosis of pancreatitis. CT and subsequent MRI revealed changes consistent with acute exacerbation on chronic pancreatitis spreading to the mediastinum and to the greater omentum. The patient received medical treatment and reported gradual improvement in his laboratory results and CT findings.

Postsplenectomy left lower lobe bronchiectasis

BACKGROUND

Bronchiectasis has decreased significantly. I describe a new underestimated clinicopathological entity of postsplenectomy left lower lobe bronchiectasis.

METHODS

This is a retrospective study on 24 patients who had a left lower lobectomy for left lower lobe bronchiectasis after splenectomy. The mean age was 34.6 years (range 18 to 63 years); there were 19 men and 5 women. The available data included history, radiological investigations (ultrasonography and computed tomography of the chest and abdomen), operative data, postoperative complications, and follow-up data.

RESULTS

All patients had a history of splenectomy and 10 had undergone subphrenic collection drainage either percutaneously or through open drainage a few years prior to the left lower lobectomy. Fourteen patients were lost to follow-up. The mean follow-up in 10 patients was 5.8 years (range 2 to 13 years).

CONCLUSIONS

Postsplenectomy left lower lobe bronchiectasis is an underestimated clinicopathological entity of bronchiectasis. It can be managed by a left lower lobectomy, with acceptable results.

A rare cause of haemoptysis

A 59-year-old man was admitted with haemoptysis, several months after a car accident. A diagnostic work-up including laboratory testing, chest radiograph and bronchoscopy could not explain the haemoptysis. A pancreatic-pulmonary fistula was suspected by additional CT scan. Magnetic resonance cholangiopancreaticography confirmed the diagnosis, followed by surgical exploration and repair.

A Pancreaticobronchial Fistula Associated With Previous Trauma and Pancreas Pseudocysts: A Case Report

We describe a rare case of a pancreaticobronchial fistula caused by pancreatic pseudocysts due to previous trauma. A 54-year-old man with a history of traumatic hemothorax was referred to central hospital for investigations due to cough, dyspnea, vertigo and fever. An ultrasound scan and abdominal computed tomography scan showed huge pancreatic pseudocysts around the pancreas extending to the right side of the mediastinum with gas. The etiology for the pseudocysts was unconfirmed. First, the patient recovered with antibiotics and external pseudocyst drainage. After five months the patient started to suffer from respiratory symptoms again, such as coughing with sputum, dyspnea and mild fever. The computer tomography scan confirmed the pancreaticobronchial fistula as a diagnosis and the patient was referred to the university hospital for further treatment.