A CASE OF RECURRENT PLEURAL EFFUSION FROM PANCREATICO PLEURAL FISTULA: DIAGNOSIS AND MANAGEMENT

Pleural effusion and mediastinal pseudo cysts in Acute Pancreatitis are common but that of in association with chronic pancreatitis and trauma is rare and occurs only if fistulous communication develops between pancreatic ductal system and pleural space or due to direct extension of pseudo cyst into pleural cavity through mediastinum. The diagnosis of fistula can be made with high index of clinical suspicion and can be confirmed by elevated amylase and protein content in pleural fluid. The actual fistulous tract can be demonstrable by MDCT, MRCP (Magnetic resonance cholangio pancreaticography) and (Endoscopic retrograde Pancreatico cholangiography) ERCP Usually these fistulae resolve with conservative treatment. If not, Endoscopic retrograde cholangio pancreaticography (ERCP) guides sphincterotomy, stricture dilatation or endoprosthesis placement across the fistulous communication or surgery are the choices of treatment. We present a case of a pancreatic pleural fistula in a 30 year -old man with recurrent episodes of Left pleural effusion Radiological and biochemical investigations were performed and he was diagnosed to have a Pancreatico pleural fistula. The patient was initially treated conservatively with somatostatin analogs, symptomatic and supportive treatment including repeated pleurocentesis. for his symptoms which include recurrent pleural taping also. Finally, endoscopic retrograde cholangio pancreatography was performed due to failed conservative treatment and a stent was placed in the pancreatic duct for healing of the fistulous communication.