Ahmed Dirweesh, MD
Minneapolis, Minnesota
Ahmed Dirweesh, MD, Christopher Choo, MD, Stuart Amateau, MD, PhD, Nabeel Azeem, MD, Shawn Mallery, MD, Martin Freeman, MD, Guru Trikudanathan, MD
University of Minnesota, Minneapolis, MN
Introduction: Pancreaticopleural fistula (PPF) is a rare sequelae of necrotizing pancreatitis (NP) consequent to pancreatic duct (PD) disruption. Due to low prevalence, experience in the management of this condition remains sparse outside specialized centers and management remains controversial. We report our center experience with PPF. The study aimed to report the demographic and clinical characteristics, management and outcomes of NP patients with radiologically confirmed PPF in our institution.
Methods: A retrospective analysis of all 515 NP patients managed at our institution between 2010-2019 was performed from a prospectively maintained database for the occurrence of PPF. Baseline characteristics, clinical presentation, management and outcomes were evaluated.
Results: Five white patients (three males and two females, median age 51 years [range, 38-63 years]) with PPF were managed in our institution during the study period, with a prevalence of 1%. The etiology of pancreatitis was alcohol in three and idiopathic in two. All patients had documented exudative pleural effusion with amylase content >1,000 U/L.
All patients underwent computerized tomography (CT), magnetic resonance imaging (MRI) and/or sinogram studies to delineate the fistula and site of PD disruption. All patients required ERCP with PD stenting and/or chest tube placement. No patient required surgical intervention. Four patients (75%) remain well at a median follow up of 6 months, while one died during the same hospitalization (25%).
Discussion: Pancreaticopleural fistulae can present a challenging diagnostic dilemma and require a high index of clinical suspicion. Early recognition and a multi-disciplinary approach in centers with specialized experience are vital for successful management of this condition.
Citation: Ahmed Dirweesh, MD, Christopher Choo, MD, Stuart Amateau, MD, PhD, Nabeel Azeem, MD, Shawn Mallery, MD, Martin Freeman, MD, Guru Trikudanathan, MD. P1820 - MANAGEMENT OF PANCREATICOPLEURAL FISTULA IN NECROTIZING PANCREATITIS: A SINGLE TERTIARY CARE CENTER EXPERIENCE. Program No. P1820. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.