ArticleInternational journal of surgery case reports2026
Pancreaticopleural fistula originated from a tiny pancreatic pseudocyst: a case report and literature review.
Article in International journal of surgery case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction and importance: Pancreatic pseudocysts (PPCs) cause two-thirds of pancreatic cystic diseases; pancreaticopleural fistula (PPF), a rare (0.4% in pancreatic diseases) life-threatening complication, occurs when mediastinal pseudocysts (60% from PPCs) rupture into the thorax, with 4.5% risk in PPC patients (highest in middle-aged males with alcohol-related chronic pancreatitis). Its nonspecific symptoms (dyspnea, mild/absent abdominal pain) delay diagnosis. Case presentation: A 44-year-old male with a 3-year recurrent acute pancreatitis and hyperlipidemia was admitted for sudden dyspnea. Labs showed elevated serum/thoracentesis fluid pancreatic enzymes. Imaging (July 2023-April 2025) revealed pancreatic inflammation → pseudocyst → mediastinal cyst coalescence → left pleural effusion. Diagnosed with PPF, he received ultrasound-guided thoracentesis and supportive care; a 2-month follow-up showed resolved effusion and a smaller pseudocyst. Clinical discussion: PPF forms via intracystic pressure elevation, diaphragmatic defects, etc., mostly causing left effusions. Diagnosis relies on pleural fluid amylase (>1000 IU/L), contrast-enhanced computed tomography (CT) (gold standard), and magnetic resonance cholangiopancreatography/ endoscopic retrograde cholangiopancreatography. Treatment includes conservative management (30%-60% success), endoscopic stenting (50%-86.36% cure), and surgery (for refractory cases). Conclusion: Clinicians should suspect PPF in PPC patients with unexplained respiratory symptoms. Prompt CT and pleural fluid testing aid diagnosis; early management and follow-up improve outcomes.
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