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Pancreatic-pleural fistula from tail pseudocyst in a patient with pancreatic head cancer: a case report

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Abstract

A 76-year-old man was diagnosed with resectable pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. Concurrently, the patient had an approximately 2-cm cystic mass originating from the pancreatic tail. After preoperative chemotherapy for the resectable PDAC, the patient is presented with dyspnea and lower left thoracic pain. Chest X-ray revealed massive left pleural effusion, and laboratory analysis of the pleural fluid showed a very high amylase level. Computed tomography confirmed a fistula directly connecting the pancreatic tail pseudocyst to the left diaphragm. These findings suggested pancreatic-pleural fistula (PPF) from the pancreatic tail to the left pleura. Medical treatments of thoracic drainage, endoscopic pancreatic ductal drainage, and antibiotics were unsuccessful; therefore, a distal pancreatectomy, fistula closure, and thoracoscopic pleural decortication were performed before the pancreaticoduodenectomy for the PDAC. After surgery, the pleural effusion resolved and the symptoms were improved immediately. PPF is an uncommon complication in which pancreatic enzymes drain directly into the pleural cavity. Herein, we present a rare case of PPF after preoperative chemotherapy for PDAC with a review of the literature.

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References

  1. Bąk M, Murawa D (2020) Pancreatic-pleural fistula presenting as epigastric pain. Pol Przegl Chir 92(4):54–57

    PubMed  Google Scholar 

  2. Bedingfield JA, Anderson MC (1986) Pancreatopleural fistula. Pancreas 1(3):283–290

    Article  CAS  Google Scholar 

  3. Bishop JR et al (2003) Pancreaticopleural fistula: a rare cause of massive pleural effusion. J Pediatr Gastroenterol Nutr 36(1):134–137

    Article  Google Scholar 

  4. Boudaya MS et al (2007) Hemothorax as the clinical presentation of a pancreaticopleural fistula: report of a case. Surg Today 37(6):518–520

    Article  Google Scholar 

  5. Cameron JL et al (1976) Internal pancreatic fistulas: pancreatic ascites and pleural effusions. Ann Surg 184(5):587–593

    Article  CAS  Google Scholar 

  6. Francisco E et al (2015) Pancreaticopleural fistula: an unusual complication of pancreatitis. BMJ Case Rep. https://doi.org/10.1136/bcr-2014-208814

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kord Valeshabad A et al (2018) Pancreaticopleural fistula: a review of imaging diagnosis and early endoscopic intervention. Case Rep Gastrointest Med 2018:7589451

    PubMed  PubMed Central  Google Scholar 

  8. Miyamoto T et al (2019) Cancer of the pancreatic body associated with a pancreatic pleural effusion-A case report. Suizo 34(2):106–113

    Article  Google Scholar 

  9. Rockey DC, Cello JP (1990) Pancreaticopleural fistula. Report of 7 patients and review of the literature. Medicine (Baltimore) 69(6):332–344

    Article  CAS  Google Scholar 

  10. Saito K et al (2020) J Soc Ibaraki Kouseiren Hosp 32:29–31 (Japanese only)

  11. Sankarankutty M et al (1978) Adenocarcinoma of the pancreas with massive pleural effusion. Br J Clin Pract 32(10):294–297

    CAS  PubMed  Google Scholar 

  12. Shimaoka S et al (2003) Minute carcinoma of the pancreas presenting as pancreatic pleural effusion. J Gastroenterol 38(9):900–904

    Article  Google Scholar 

  13. Sugiyama Y et al (2010) A case of pancreatic carcinoma presenting as pancreaticopleural fistula with pancreatic pleural effusion. Nihon Shokakibyo Gakkai Zasshi 107(5):784–791

    PubMed  Google Scholar 

  14. Tay CM, Chang SK (2013) Diagnosis and management of pancreaticopleural fistula. Singapore Med J 54(4):190–194

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6, SendaMachi, Naka-ku, Hiroshima, Japan

    Jin Shiraishi, Kyohei Yugawa, Shigeyuki Nagata & Takashi Maeda

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  1. Jin Shiraishi
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  2. Kyohei Yugawa
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  3. Shigeyuki Nagata
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  4. Takashi Maeda
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Correspondence to Takashi Maeda.

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Shiraishi, J., Yugawa, K., Nagata, S. et al. Pancreatic-pleural fistula from tail pseudocyst in a patient with pancreatic head cancer: a case report. Int Canc Conf J 11, 261–265 (2022). https://doi.org/10.1007/s13691-022-00555-w

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  • DOI: https://doi.org/10.1007/s13691-022-00555-w

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