EUH Krakow Conference: Are there instances of pancreatic ductal leaks into pleural effusions?

The Bottom Line: Yes. Pancreatic ductal leaks, or pancreatic duct disruption, are often  complications of acute pancreatitis (AP) or chronic pancreatitis (CP). However, no published cases were identified regarding ductal leaks into pleural effusions as result of trauma.

References: King JC, Reber HA, Shiraga S, Hines OJ. Pancreatic-pleural fistual is best managed by operative care. Surgery. 2010 Jan; 147(1): 154-159. doi:10.1016/j.surg.2009.03.024.

Ross A, Waxman I, Prachand VN. Endoscopic and minimally invasive therapy for complications of acute and chronic pancreatitis. In Shakelford’s Surgery of the Alimentary Tract (7th ed). 2013:1168-1178.

Summary: Virtually every case of AP involves some form of duct leak, which may or may not persist. Persistent leaks in the setting of acute pancreatitis can lead to pancreatic ascites and high amylase pleural effusions, pancreaticobiliary fistula, as well as the disconnected duct syndrome. In patients with CP, leaks are invariably associated with a downstream calculus or stricture. Endoscopy plays a significant role in the management of duct leaks in each of these clinical scenarios.

Also, pancreatic-pleural fistula is an uncommon complication of chronic pancreatitis occurring as a result of disruption of the main pancreatic duct and tracking of pancreatic fluid through the retroperitoneum into 1 or both thoracic cavities. In a review of cases from 1970 to 2008, King et al (2010) found that a majority of patients recover from pancreatic–pleural fistula without sequelae (81%). Attempts at prolonged periods of medical therapy tend to delay the resolution of the fistula compared with patients who undergo definitive operative intervention early in the course of treatment.

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