Yang Jing, Lu Lei, Jin Hang-Bin, Yang Jian-Feng, Zhang Xiao-Feng
Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Medicine (Baltimore). 2020 Jun 5;99(23):e20657. doi: 10.1097/MD.0000000000020657.
Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disorders. As the clinical presentations of PPF are often deceptive, it can cause a delay in the timely diagnosis and proper treatment. PPF is extremely uncommon in pediatric patients, and diagnostic and management strategies for PPF among pediatric patients are scanty.
A 12-year-old girl presented with cough and dyspnea owing to massive right-side pleural effusion confirmed by Chest X-ray. Biochemical examination of pleural effusion revealed a significant elevation of amylase level. Imaging modalities showed dilated pancreatic duct and fistulous tract connecting pancreatic duct and right thorax.
Chronic pancreatitis with PPF was diagnosed.
Medical therapy was initially attempted for 2 weeks. Endoscopic therapy with naso-pancreatic drainage tube placement was then performed without any complications after failed medical therapy.
The patient has remained healthy and symptom-free during 2 years of follow-up.
When pediatric patients presented with recurrent pleural effusion with unknown etiology, PPF should be taken into consideration. Pleural effusion amylase level is the most important laboratory test and magnetic resonance cholangiopancreatography is recommended to visualize the fistula. Optimal management of PPF should be based on pancreatic duct morphology.
胰胸膜瘘（PPF）是胰腺疾病罕见但严重的并发症。由于PPF的临床表现常常具有欺骗性，可能导致诊断和恰当治疗的延迟。PPF在儿科患者中极为罕见，儿科患者中PPF的诊断和管理策略也很少。
一名12岁女孩因咳嗽和呼吸困难就诊，胸部X线证实右侧大量胸腔积液。胸腔积液生化检查显示淀粉酶水平显著升高。影像学检查显示胰管扩张以及连接胰管和右胸的瘘管。
诊断为慢性胰腺炎合并PPF。
最初尝试药物治疗2周。药物治疗失败后，进行了内镜下鼻胰引流管置入治疗，未出现任何并发症。
在2年的随访期间，患者一直保持健康且无任何症状。
当儿科患者出现病因不明的反复胸腔积液时，应考虑PPF。胸腔积液淀粉酶水平是最重要的实验室检查，建议采用磁共振胰胆管造影来观察瘘管。PPF的最佳管理应基于胰管形态。
