A RARE CASE REPORT OF PANCREATICOPLEURAL FISTULA WRONGLY DIAGNOSED AS PULMONARY TUBERCULOSIS

Dr. Shaheed Arman Khondekar*, Dr. Rajbir Singh and Dr. Arjun Sharma

ABSTRACT

Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis that requires a high index of clinical suspicion as patients typically present with pulmonary symptoms related to the pleural effusion rather than pancreatitis. Diagnosis is made by detection of amylase in the pleural fluid. Magnetic resonance cholangiopancreatography can aid in visualizing the fistula. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst, abdominal complaints are usually less or present late. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT, Endoscopic retrograde cholangiopancreatography (ECRP) or magnetic resonance cholangiopancreatography (MRCP) may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management.

Keywords: pancreaticopleural fistula, pleural effusion, pancreatitis.