Bridging the Divisum: A Rare Case of Pancreaticopleural Fistula in the Setting of Complete Pancreatic Divisum Treated Endoscopically

Overview

Journal J Investig Med High Impact Case Rep

Specialty General Medicine

Date 2020 Oct 16

PMID 33063539

Authors

Rachel Peterson

Samiran Mukherjee

Prateek Suresh Harne

Sahir Quraeshi

Anuj Vikrant Sharma

Umair Masood

Divey Manocha

Affiliations

Soon will be listed here.

Abstract

A pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis that occurs either due to a pancreatic duct disruption or a pseudocyst extension. A pancreatic divisum, on the other hand, is a common anatomic variant of the pancreas that is rarely symptomatic. We describe a case of recurrent pleural effusion in a patient with a history of chronic pancreatitis. Investigations revealed the presence of a PPF and a concomitant complete pancreatic divisum. There was resolution of the pleural effusion on endoscopic therapy. This is the fourth reported case of a PPF in the setting of complete pancreatic divisum and the first reported case in a middle-aged female.

References

Sanz Y, Olivares M, Moya-Perez A, Agostoni C . Understanding the role of gut microbiome in metabolic disease risk. Pediatr Res. 2014; 77(1-2):236-44. DOI: 10.1038/pr.2014.170. View

Tombroff M, Loicq A, de Koster J, Engleholm L, Govaerts J . Pleural effusion with pancreaticopleural fistula. Br Med J. 1973; 1(5849):330-1. PMC: 1588200. DOI: 10.1136/bmj.1.5849.330. View

Miyachi A, Kikuyama M, Matsubayashi Y, Kageyama F, Sumiyoshi S, Kobayashi Y . Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: a case report. Gastrointest Endosc. 2004; 59(3):454-7. DOI: 10.1016/s0016-5107(03)02719-6. View

Cooper S, Malick J, McGrath K, Slivka A, Sanders M . EUS-guided rendezvous for the treatment of pancreaticopleural fistula in a patient with chronic pancreatitis and pancreas pseudodivisum. Gastrointest Endosc. 2009; 71(3):652-4. DOI: 10.1016/j.gie.2009.08.017. View

Aswani Y, Hira P . Pancreaticopleural fistula: a review. JOP. 2015; 16(1):90-4. DOI: 10.6092/1590-8577/2915. View

Dhebri A, Ferran N . Nonsurgical management of pancreaticopleural fistula. JOP. 2005; 6(2):152-61. View

Vanderbruggen W, Dhooghe V, Bracke B, Hartman V, Roeyen G, Ysebaert D . Pancreaticopleural fistula: a rare cause of pleural empyema. Acta Chir Belg. 2018; 119(6):396-399. DOI: 10.1080/00015458.2018.1470293. View

Shah D, Bhagirath Desai A, Salvi B . Pancreaticopleural fistula complicating chronic pancreatitis. BMJ Case Rep. 2012; 2012. PMC: 4543080. DOI: 10.1136/bcr-03-2012-6038. View

Koshitani T, Uehara Y, Yasu T, Yamashita Y, Kirishima T, Yoshinami N . Endoscopic management of pancreaticopleural fistulas: a report of three patients. Endoscopy. 2006; 38(7):749-51. DOI: 10.1055/s-2006-925062. View

10.

Takuma K, Kamisawa T, Tabata T, Egawa N, Igarashi Y . Pancreatic diseases associated with pancreas divisum. Dig Surg. 2010; 27(2):144-8. DOI: 10.1159/000286975. View

11.

Nacoti M, Riva L, Vedovati S, Bolis A, Agazzi R, Fumagalli R . Internal pancreatic fistula in a child with pancreas divisum: An unusual manifestation of an uncommon anomaly. Pediatr Crit Care Med. 2006; 7(2):174-6. DOI: 10.1097/01.PCC.0000200970.11633.C3. View

12.

Wypych K, Serafin Z, Galazka P, Strzesniewski P, Matuszczak W, Nierzwicka K . Pancreaticopleural fistulas of different origin: Report of two cases and a review of literature. Pol J Radiol. 2012; 76(2):56-60. PMC: 3389915. View

13.

Sarkar T, Jagroop S . A Case of Late Presentation of Pancreatic Divisum in a Patient with Recurrent Pancreatitis. Case Rep Med. 2020; 2020:3437465. PMC: 7376419. DOI: 10.1155/2020/3437465. View

14.

Jacob L, GEENEN J, Catalano M, Johnson G, Geenen D, Hogan W . Clinical presentation and short-term outcome of endoscopic therapy of patients with symptomatic incomplete pancreas divisum. Gastrointest Endosc. 1998; 49(1):53-7. DOI: 10.1016/s0016-5107(99)70445-1. View

15.

Neher J, Brady P, Pinkas H, Ramos M . Pancreaticopleural fistula in chronic pancreatitis: resolution with endoscopic therapy. Gastrointest Endosc. 2000; 52(3):416-8. DOI: 10.1067/mge.2000.108296. View

16.

Ali T, Srinivasan N, Le V, Chimpiri A, Tierney W . Pancreaticopleural fistula. Pancreas. 2008; 38(1):e26-31. DOI: 10.1097/MPA.0b013e3181870ad5. View

17.

Gurram K, Czapla A, Thakkar S . Acute pancreatitis: pancreas divisum with ventral duct intraductal papillary mucinous neoplasms. BMJ Case Rep. 2014; 2014. PMC: 4187421. DOI: 10.1136/bcr-2014-205322. View

18.

Horiguchi Y, Hayakawa T, Noda A, Takayama T, Nimura Y, Hattori T . Pancreatic internal fistula to the left pleural cavity. Am J Gastroenterol. 1978; 70(1):85-6. View