Hemothorax as the clinical presentation of a pancreaticopleural fistula: report of a case

TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS COMPLICATED BY PANCREATORAGIA

OBJECTIVE

The aim: To present and share our experience in the treatment of pancreatoragia which could help to prevent pancreatoragia in patients with chronic pan¬creatitis in the pre- and postoperative period.

PATIENTS AND METHODS

Materials and methods: Surgical treatment of complicated chronic pancreatitis (CP) was performed on 249 patients in the surgical clinic of the medical faculty №2 of National Pirogov Memorial Medical University of Vinnytsia during 2000 - 2021. Pancreatorrhagia occurred in 6 (2.4%) patients, group A - 3 (1.2%) - as disease manifestation, group B - 3 (1.2%) - as complication after surgery. In group A the source of bleeding was the lower pancreato-duodenal artery: 2 (0.8%) had lower pancreaticoduodenal artery aneurysms with bleeding into the cyst, 1 (0.4%) - a year after previously performed pancreato-duodenal resection. In group B pancreatorrhagia developed in 3 (1.2%) patients after the Frey-Izbitsky local resection of the pancreas: 2 (0.8%) - from pancreato-jejuno anastomosis, 1(0.4%) - from pancreatopleural fistula.

CONCLUSION

Conclusions: Pancreatoragia, as a manifestation of chronic pancreatitis, occurred in 6 (2.4%) patients. Bleeding occurred as a manifestation of the disease in 3 (1.2%) patients and in 3 (1.2%) patients - in the postoperative period. It is possible to use fibrin or cyanoacrylate glue to filling the defect of the pancreatic duct or to suture vessels in the parenchyma of the pancreas by PDS for the prevention of pancreatoragia in the postoperative period.

Staged Interventional and Surgical Treatment of Patient with Chronic Pancreatitis Complicated by Pancreaticopleural Fistula with Lung Abscesses

Patient: Male, 37-year-old

Final Diagnosis: Chronic alcoholic pancreatitis • pancreaticopleural fistula • left lung abscesses

Symptoms: Fever with a body temperature of 39.1°C • left thoracic pain • severe cough with purulent sputum • shortness of breath • upper abdominal pain

Medication: —

Clinical Procedure: Repeated thoracenteses • chest tube • drainage of lung abscesses • ultrasound-guided drainage of pancreatic pseudocyst • ultrasound-guided transparietal external-internal pancreatic duct stenting • Bern modification of Beger procedure

Specialty: Surgery

Pancreaticopleural Fistula: A Review of Imaging Diagnosis and Early Endoscopic Intervention

A 49-year-old male with history of chronic alcohol-induced pancreatitis presented with one month of worsening left pleuritic chest pain and shortness of breath. Chest radiograph demonstrated bilateral pleural effusions. Thoracentesis revealed increased amylase in the pleural fluid. Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a fistula tract between the left pleural cavity and pancreas which was confirmed on endoscopic retrograde cholangiopancreatography (ERCP). Patient was treated with placement of a pancreatic stent with complete resolution of the fistula tract approximately in 9 weeks. A systematic literature search was performed on reported cases with pancreaticopleural fistula (PPF) who underwent early therapeutic endoscopy within the last 10 years. Imaging modalities, particularly CT and MRCP, play essential role in prompt preprocedural diagnosis of PPF. Early therapeutic ERCP is an effective and relatively safe treatment option for PPF, so invasive surgery may be avoided.

Intra-thoracic pancreatic pseudocyst: a rare complication of traumatic pancreatitis

The commonest complication of traumatic pancreatitis is the development of pancreatic pseudocyst. We report a patient with traumatic pancreatitis following blunt abdominal trauma who developed an intrathoracic pancreatic pseudocyst late in the course of non-operative management, and discuss the management of this very rare complication of traumatic pancreatitis.

Pancreaticopleural fistula presenting as right-sided hemothorax

Pancreaticopleural fistula represents a rare complication of pancreatitis. We report the case of a pancreaticopleural fistula presenting as recurrent right-sided hemothorax in a 43-year-old man. The patient was successfully treated with open surgical drainage and decortication, followed by octreotide, total parenteral nutrition, and stent placement in the pancreatic duct.