P0048 - A Rare Case of Pleural Effusion Due to a Pancreatico-Pleural Fistula in the Setting of Pancreas Divisum

Presenting Author(s)

• SM

  Samiran Mukherjee, MBBS

  Syracuse, New York

Samiran Mukherjee, MBBS¹, Prateek Harne, MBBS², Anuj Sharma, MD³, Umair Masood, MD¹, Divey Manocha, MD¹

¹SUNY Upstate Medical University, Syracuse, NY; ²State University of New York Upstate University Hospital, Syracuse, NY; ³State University of New York Upstate Medical Center, Syracuse, NY

Introduction: A pancreatico pleural fistula is a rare complication of pancreatitis which classically results from a pancreatic duct disruption or a pseudocyst extension into the pleural cavity. The literature present on this condition continues to remain sparse. We attempt to present a rare case of a pancreatico-pleural fistula in the setting of a congenital pancreatic anomaly which initially presented as a recurrent pleural effusion in the setting of chronic pancreatitis.

Case Description/Methods: Our patient was a 51 year old female who presented with intractable abdominal pain and shortness of breath with a confirmed diagnosis of a pancreatic pseudocyst. On admission, her chest Xray was significant for pleural effusion.  Further analysis of the pleural fluid revealed the presence of elevated lipase and amylase levels. The patient eventually underwent an ERCP with contrast that revealed contrast leakage tracking upwards from the dorsal pancreatic duct suggesting a pancreatico-pleural fistula. This was in addition to the inability to fill the ventral pancreatic duct, suggesting a complete pancreatic divisum. A pancreatic duct plastic stent was placed and the  pleural effusion gradually subsequently subsided.

Discussion: The case allows us to consider one of the lesser known etiologies of pleural effusion in the setting of pancreatitis (the other one being transdiaphragmatic lymphatic blockage) and provides us with an opportunity to develop a step to manage the same. This is the only known case report of a pancreatico-pleural fistula with a concomitant complete pancreatic divisum.

 References;

1)Ali T et al, Pancreaticopleural fistula. Pancreas. 2009 Jan;38(1):e26-31

 2)Safadi BY, Marks JM, Pancreatic-pleural fistula: the role of ERCP in diagnosis and treatment. Gastrointest Endosc. 2000 Feb;

 3)Kaman L, Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. ANZ J Surg. 2001 Apr

Disclosures:

Citation: Samiran Mukherjee, MBBS; Prateek Harne, MBBS; Anuj Sharma, MD; Umair Masood, MD; Divey Manocha, MD. P0048 - A RARE CASE OF PLEURAL EFFUSION DUE TO A PANCREATICO-PLEURAL FISTULA IN THE SETTING OF PANCREAS DIVISUM. Program No. P0048. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.