Publication:

Management of pancreatico-pleural fistula: 5 years of experience

Background Pancreatico-pleural fistula is a rare entity with an incidence of 0.4% seen both in patients with acute and chronic pancreatitis or may follow traumatic and surgical disruption of the pancreatic duct. It presents as massive pleural fluid accumulation and has a high tendency to recur following treatment. Conservative management like inhibition of pancreatic secretion with octreotide and pancreatic duct stenting may help fistula closure in about 31 to 45% of cases. Surgical correction has high mortality up to 10% and but has increased fistula closure rate of 80-90%. Here we present our experience with pancreatico-pleural fistula.

Methods Data of patients admitted with pancreatico-pleural fistula from 2010-2015 in our department were retrospectively analysed. Ten patients were included in this analysis. The average age of presentation was 28.3 years.

Results There were 8 male and 2 female patients. Alcoholic pancreatitis - most common cause with chronic pancreatitis (80% n = 8), idiopathic pancreatitis (20% n=2). Mean hospital stay was 18 days; intercostal drainage and inj. octreotide were done in all patients; ERCP (n=5; In 4 patients successful PD stenting was done and in 1 patient could not be done; four patients required pigtail drainage for peripancreatic collection. Recurrence (20% n = 2); Surgery in 3; Mortality – nil.

Conclusions Pancreatico-pleural presents with significant morbidity but can be managed effectively with medical therapy and ERCP stenting in most of the patients. Surgery may be required for failed conservative therapy or for recurrences.