胰胸膜瘘继发持续性单侧胸腔积液的罕见病例。
Unusual case of persistent unilateral pleural effusion secondary to pancreaticopleural fistula.
作者信息
El-Beialy Hesham, Fernandez Ivo
机构信息
Department of Surgery, International Hospital of Bahrain, P.O. Box 1084, Manama, Bahrain.
出版信息
Int J Surg Case Rep. 2012;3(9):435-6. doi: 10.1016/j.ijscr.2012.04.018. Epub 2012 May 14.
INTRODUCTION
Pancreaticopleural fistula is rare. It occurs as a complication in acute and chronic pancreatitis. Here we report a case of persistent unilateral pleural effusion secondary to pancreaticopleural fistula.
PRESENTATION OF CASE
A 37 year old non alcoholic gentleman who had no history of pancreatitis and presented with breathlessness and tachypenia. X-ray chest showed massive pleural effusion on the right side. Amylase estimation of the tapping fluid was very high. ERCP showed a pancreaticopleural fistula.
DISCUSSION
Pancreaticopleural fistula is a rare entity with an incidence of 0.4-4.5%. It occurs either as a complication in pancreatitis, or after injury of the pancreatic duct. A greatly elevated pleural fluid amylase is usually the first step towards the diagnosis. ERCP and CT will identify the fistulous tract in 70%. Treatment is mainly directed towards intercostal drainage and control of the fistula.
CONCLUSION
Presentation is misleading in most of cases and needs aware clinicians with a high index of suspicion.
引言
胰胸膜瘘较为罕见。它作为急性和慢性胰腺炎的一种并发症出现。在此，我们报告一例继发于胰胸膜瘘的持续性单侧胸腔积液病例。
病例介绍
一名37岁无酒精摄入史的男性，既往无胰腺炎病史，因呼吸急促和呼吸过速就诊。胸部X线显示右侧大量胸腔积液。抽取液淀粉酶测定值非常高。内镜逆行胰胆管造影（ERCP）显示存在胰胸膜瘘。
讨论
胰胸膜瘘是一种罕见疾病，发病率为0.4 - 4.5%。它可作为胰腺炎的并发症出现，也可在胰管损伤后发生。胸腔积液淀粉酶大幅升高通常是诊断的首要线索。ERCP和CT在70%的病例中可识别瘘管。治疗主要针对肋间引流和控制瘘管。
结论
大多数情况下，临床表现具有误导性，需要临床医生保持高度怀疑指数。
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