PANCREATICO-PLEURAL FISTULA- A RARE SEQUELAE OF PANCREATITIS

Introduction: Pancreaticopleural fistula is an uncommon complication of pancreatitis, presenting both diagnostic and therapeutic challenges. The following case report highlights the distinctive difficulties associated with pancreaticopleural fistula. The objective is to provide valuable insights to the scientific literature by detailing the case of a middle-aged gentleman suffering from sequelae of acute pancreatitis and left sided pleural effusion.

Materials And Method: A 41 year-old gentleman with a history of acute pancreatitis and chronic alcohol use presented with breathlessness, fever, chest pain, and abdominal pain. Computed tomography showed a pseudocyst involving the tail of pancreas & Spleen, a large left-sided pleural effusion and a moderate right-sided pleural effusion, along with signs of pneumonitis. Analysis of the pleural fluid from left pleural cavity revealed markedly elevated levels of Amylase. A MRCP (Abbrev) confirmed the findings & suggested a pancreaticopleural fistula.

Results: Following a multidisciplinary consensus, an intercostal drainage tube was inserted into the left pleural cavity preoperatively. He was started on Octreotide therapy, and underwent nutritional & pulmonary optimization for elective surgery. He underwent a distal pancreato-splenectomy. Postoperative period was uneventful. He is doing well on 6 months of followup.

Conclusion: The management of pancreaticopleural fistula demands a comprehensive and individualized approach. Recognition guided by high clinical suspicion coupled with appropriate investigations and a careful balance between medical and surgical interventions is crucial for achieving favorable outcomes. This case report adds to the scientific literature by providing insights into the complexities of sequelae of pancreatitis and emphasizes the importance of individualized strategies in their management.