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• W4387248030 abstract "SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters 15 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: The United European Journal of Gastrointestinal Medicine estimates the annual prevalence of chronic pancreatitis is ~130 cases per 100,000 patients (1). Chronic pancreatitis can cause complications, including pancreatic pseudocysts, ascites, pleural effusions, splenic vein thrombosis, endocrine insufficiency, and cancer (2). We present a patient who developed one of the rarest of the aforementioned complications: pancreatic pleural effusion. This phenomenon was thought to be secondary to pancreatic pseudocyst rupture forming a fistulous tract resulting in a right hydropneumothorax. CASE PRESENTATION: A 34-year-old male with past medical history of chronic alcoholic pancreatitis (with recurrent acute exacerbations) presented for abdominal pain and distension secondary to abdominal ascites; paracentesis revealed fluid studies suggestive of intrabdominal infection. Computerized tomography (CT) of the abdomen demonstrated moderate volume ascites and multiple rounded hypodensities involving the pancreas, stomach, and subcapsular and intrahepatic regions of the liver suggestive of pseuodocysts. The patient was treated with antibiotics and discharged. Four months later, the patient was readmitted with a large, right-sided pleural effusion. Thoracentesis revealed 1500 mL of dark, bilious fluid with fluid studies suggesting an exudative effusion and amylase >2400 U/L. Magnetic resonance cholangiopancreatography demonstrated a linear collection extending from the pancreatic neck to the right pleural space representative of a pancreaticopleural fistula. Endoscopic retrograde cholangiopancreatography was subsequently performed with pancreatic duct stent placement. Weeks later, the patient was readmitted with right upper quadrant pain and shortness of breath with recurrence of the pleural effusion. Octreotide was administered to reduce output of the fistula, and repeat thoracentesis was performed with plan for continued outpatient surveillance of the pancreaticopleural effusion. DISCUSSION: Fewer than 10 percent of patients with chronic pancreatitis and pseudocyst formation will develop ascites, and fewer will develop a pancreaticopleural effusion from a fistula (3). Pancreaticopleural effusions are exudative with amylase levels > 1,000 IU/L and protein above 3.0g/dL with imaging demonstrating pancreatic pseudocyst rupture or pancreatic duct disruption; these are diagnostic features of pancreaticopleural effusions (4,5). Management begins conservatively with octreotide to decrease pancreatic secretions. Patients may require endoscopic stenting and bridging of the pancreatic duct; surgery is indicated if endoscopic management fails (6). CONCLUSIONS: Providers must have a high index of suspicion for this conditions, as reported delays in diagnosis can be up to 1 month. Therefore, pancreaticopleural fistula should not be neglected as a differential diagnosis in a patient with chronic pancreatitis (7). REFERENCES: 1. Lévy P, Domínguez-Muñoz E, Imrie C, Löhr M, Maisonneuve P. Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol j. 2014;2(5):345-354. doi:10.1177/2050640614548208 2. Ramsey ML, Conwell DL, Hart PA. Complications of Chronic Pancreatitis. Dig Dis Sci. 2017;62(7):1745-1750. doi:10.1007/s10620-017-4518-x 3. Chmielecki J, Kościński T, Banasiewicz T. Pancreaticopleural Fistula as a Rare Cause of Both-Sided Pleural Effusion. Case Rep Surg. 2021;2021:6615612. doi:10.1155/2021/6615612 4. Ramsey ML, Conwell DL, Hart PA. Complications of Chronic Pancreatitis. Dig Dis Sci. 2017;62(7):1745-1750. doi:10.1007/s10620-017-4518-x 5. Wronski M, Slodkowski M, Cebulski W, Moronczyk D, Krasnodebski IW. Optimizing management of pancreaticopleural fistulas. World J Gastroenterol. 2011;17(42):4696-4703. doi:10.3748/wjg.v17.i42.4696 6. Mutignani M, Dokas S, Tringali A, et al. Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification. Dig Dis Sci. 2017;62(10):2648-2657. doi:10.1007/s10620-017-4697-5 7. Uchiyama T, Suzuki T, Adachi A, Hiraki S, Iizuka N. Pancreatic pleural effusion: case report and review of 113 cases in Japan. Am J Gastroenterol. 1992;87(3):387-391. DISCLOSURES: No relevant relationships by Shawn Nishi No relevant relationships by Ramya Sunku No relevant relationships by Abigail Watts No relevant relationships by Mohammed Zaidan" @default.
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• W4387248030 title "CHRONIC ALCOHOLIC PANCREATITIS COMPLICATED BY A PANCREATICOPLEURAL FISTULA: A CASE REPORT" @default.
• W4387248030 doi "https://doi.org/10.1016/j.chest.2023.07.3666" @default.
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