20 April 2020
: Case report
Staged Interventional and Surgical Treatment of Patient with Chronic Pancreatitis Complicated by Pancreaticopleural Fistula with Lung Abscesses
Unusual clinical course
Nikolay Y. Kokhanenko1ABDE, Alexey A. Kashintsev12ABDEF, Andrey A. Bobylkov3ABD, Ruben G. Avanesyan45BD, Evgeniy V. Shepichev6BD, Artem L. Ivanov13BD, Lyudmila A. Solovyova1BDF, Yuri N. Shiryajev7ABDEF*DOI: 10.12659/AJCR.922195
Am J Case Rep 2020; 21:e922195
Abstract
BACKGROUND: Pancreaticopleural fistula is a rare complication of chronic pancreatitis. Its formation is associated with local disruption of the pancreatic duct or pseudocyst communicating with the ductal system. Rarely, other intrathoracic complications may develop such as mediastinitis, pericarditis, hemothorax, and pleural empyema. The combination of pancreaticopleural fistula with lung abscesses is extremely rare.
CASE REPORT: A 37-year-old male patient, a long-term alcohol abuser, was admitted with complaints on left thoracic and upper abdominal pain, fever with a body temperature of 39.1°C, and a severe cough with purulent sputum. Left-sided pneumonia with pleural effusion was diagnosed. Thoracentesis and then a pleural drainage were performed. However, the symptoms persisted. Pleural effusion amylase was very high – more than 60 000 IU/L. Computed tomography and magnetic resonance imaging revealed cystic changes in the pancreatic head, pseudocyst in the pancreatic body, dilation of the Wirsung duct, and pancreaticopleural fistula with several left lung abscesses. Step by step, the patient underwent drainage of lung abscesses, external drainage of the pancreatic pseudocyst, and external-internal stenting of the pancreatic duct under ultrasound guidance. After fistula resolution, the patient was readmitted and successfully underwent the Bern variant of the Beger procedure. Six months later, he had no complaints and returned to work. In a follow-up examination, there was no fistula, no ductal hypertension, and only small pulmonary residual changes.
CONCLUSIONS: A very rare case of chronic pancreatitis complicated by pancreaticopleural fistula with lung abscesses is presented. The clinical outcome was good due to the staged character of treatment and participation of a multidisciplinary specialist team.
Keywords: lung abscess, Pancreatic Fistula, Pancreatitis, Chronic, Drainage, Pancreas, Pancreatic Ducts, Pleural Effusion
In Press
27 Jan 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938548
26 Jan 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938169
26 Jan 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939026
26 Jan 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938982
Most Viewed Current Articles
13 Jul 2022 : Case report
DOI :10.12659/AJCR.936441
Am J Case Rep 2022; 23:e936441
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399