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• W2977720449 abstract "Introduction: Pleural effusion in a patient with pancreatic pseudocyst is a rare but serious complication that forms due to a direct connection between the pseudocyst and the pleural cavity by pancreaticopleural fistula. It may be the primary presentation in some patients having the pseudocyst and can lead to diagnostic and management difficulties. We are presenting here a case of massive pleural effusion from a pancreaticopleural fistula treated with endoscopic ultrasound (EUS)-guided cystogastrostomy. Case Report: A 23-year-old male with history of alcohol-related acute pancreatitis 1 year ago and another episode of pancreatitis with infected pseudocysts 2 months ago, presented with left-sided pleuritic chest pain, radiating to back, mild cough, clear sputum, and shortness of breath for 2 days. He denied any abdominal pain, nausea, vomiting, fever, or chills. Lab work revealed lipase 190 u/L and amylase 390 u/L. CT scan chest showed large left-sided pleural effusion, and the pseudocysts around the pancreas, as compared to the last CT scan, had decreased in size. We did thoracentesis draining 1000 cc of brownish-red exudative fluid having amylase level of 18,425 u/L, which revealed the diagnosis. A MRCP was also performed that reported collapsed pancreatic duct with no necrotizing pancreatitis, smaller pseudocysts with a larger collection remaining in the left anterior abdomen and normal biliary structures. He got a second thoracentesis 2 days later and amylase level was 27,380 u/L this time. Given his ongoing symptoms and recurrent pleural effusions he was transferred to a pancreaticobiliary center where he got pancreatic stent placement, PEG tube insertion for bowel rest, pleural catheter placement for continued drainage, and EUS-guided cystogastrostomy double stents placement. Follow-up CT scan of abdomen showed near resolution of the fluid collection in the lesser sac and interval decrease in collection in the left upper quadrant. Conclusion: Pancreaticopleural fistula can be rare complication of pseudocysts, which can be very challenging to manage. Use of amylase level in pleural fluid analysis is helpful in diagnosis. Treatment may be conservative but in some cases drainage of the pseudocysts may be required by surgical versus endoscopic measures. We have documented here a case of pancreaticopleural fistula managed by endoscopic cystogastrostomy which is associated with less morbidity as compared to the surgical options." @default.
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• W2977720449 date "2014-10-01" @default.
• W2977720449 modified "2023-09-26" @default.
• W2977720449 title "Pancreaticopleural Fistula in a Patient With Pancreatic Pseudocysts Treated With Endoscopic Cystogastrostomy" @default.
• W2977720449 doi "https://doi.org/10.14309/00000434-201410002-00336" @default.
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