Shibasaki Shin-ichi, Yamaguchi Hiroyuki, Nanashima Atsushi, Tsuji Takashi, Jibiki Masaaki, Sawai Terumitsu, Yasutake Toru, Nakagoe Tohru, Ayabe Hiroyoshi
First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Hepatogastroenterology. 2003 Sep-Oct;50(53):1678-80.
A 56-year-old man with a history of alcohol abuse presented with exertional dyspnea. A chest radiography showed a massive right pleural effusion with sanguineous pleural fluid and an amylase level of 97,188 IU/L. Despite conservative treatment with no oral intake, total parenteral nutrition and repeated thoracentesis, the pleural effusion was persistent and intrathoracic infection was suspected. Surgical intervention was proposed and a preoperative endoscopic retrograde cholangiopancreatography revealed disruption of the mid pancreatic duct and a fistulous tract. A middle segment pancreatectomy was performed for removal of the disrupted portion of the main pancreatic duct and reconstruction of the distal pancreas was completed by end-to-side Rouxen-Y pancreatojejunostomy. The patient had a good postoperative course and was discharged on the 29th postoperative day. He has remained well during the 9 months of follow-up.
