SHM Converge Scientific Abstract ePoster Gallery-A Rare Cause of Pleural Effusion. A Case of Pancreatico-Pleural Fistula With Pancreas Divisum.

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This case describes a 43-year-old woman with recurrent pancreatitis who developed a rare pancreatico-pleural fistula (PPF) causing recurrent pleural effusion and ascites. She initially presented with epigastric pain radiating to the back, fever, nausea, vomiting, abnormal liver tests, and elevated lipase. CT showed acute interstitial pancreatitis, ascites, and a peripancreatic fluid collection/pseudocyst. She was treated with endoscopic ultrasound-guided cystgastrostomy and initially improved, though she was readmitted twice with persistent abdominal pain.<br /><br />On a fourth admission, she developed severe abdominal pain and shortness of breath. Imaging showed residual pancreatitis, small stable pseudocysts, ascites, intraperitoneal fluid, and a new large right pleural effusion. Thoracostomy drained 2 liters of serous fluid, but the effusion rapidly re-accumulated, requiring reinsertion of the chest tube. Pleural fluid was positive for amylase and lipase, raising concern for PPF. Repeat ERCP revealed previously undiagnosed complete pancreas divisum, with a strictured ventral duct and leaking dorsal duct, supporting the diagnosis of a pancreatic-pleural fistula.<br /><br />The report highlights that pancreas divisum is a relatively common congenital anomaly associated with recurrent pancreatitis, while PPF is a rare but important complication that can present as pleural effusion, often with respiratory symptoms rather than prominent abdominal complaints. Diagnosis is suggested by pancreatic enzymes in pleural fluid and confirmed by imaging or ERCP/MRCP demonstrating duct disruption or fistula formation.<br /><br />The case emphasizes the need for a high index of suspicion for PPF in patients with recurrent pancreatitis and pleural effusion, and underscores the importance of a multidisciplinary approach for diagnosis and management.

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Author List Katherine M. Cooper, Alessandro Colletta, Oliver C. Marasigan

Category Clinical Vignettes

Concept Pancreaticopleural Fistula

Concept Pancreatitis

Concept Pancreatic Enzymes

Concept Pancreatic Duct Disruption

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization University of Massachusetts Medical School

Presenting Author Katherine M. Cooper

Track Adult

Keywords

recurrent pancreatitis

pancreatico-pleural fistula

pleural effusion

pancreas divisum

ascites

pancreatic pseudocyst

elevated pleural amylase

ERCP

cystgastrostomy

duct disruption

Pancreaticopleural Fistula

Pancreatitis

Pancreatic Enzymes

Pancreatic Duct Disruption

Pleural Effusion