SUNY Upstate Medical University, Syracuse, NY, USA.
J Investig Med High Impact Case Rep. 2022 Jan-Dec;10:23247096221099269. doi: 10.1177/23247096221099269.
Chronic pancreatitis presents with epigastric abdominal pain, nausea, vomiting, and weight loss. Acute pancreatitis can also present with a pleural effusion which is typically left-sided, mild in nature, and self-limiting. However, recurrent bouts of pancreatitis may lead to a pancreaticopleural fistula (PPF) with a large, rapidly recurring, unilateral pleural effusion. Among patients with PPF, the most common presenting complaint is dyspnea. We present the case of a 53-year-old man with recurrent bouts of pancreatitis in the setting of alcohol who presented with progressively worsening shortness of breath. A high-resolution computed topography scan of the thorax demonstrated a large right-sided pleural effusion. A thoracentesis was performed with pleural fluid studies showing an exudative effusion with amylase significantly elevated at 18 382 U/L. An endoscopic retrograde cholangiopancreatography was performed which showed a pancreatic duct leak in the tail of the pancreas. A pancreatic sphincterotomy was performed, and a stent was placed into the ventral pancreatic duct. The patient's shortness of breath improved, and he was discharged home with outpatient follow-up. The aim of this report is to present the diagnosis of a rare complication of chronic pancreatitis and discuss the management and options for treatment.
慢性胰腺炎的表现为上腹痛、恶心、呕吐和体重减轻。急性胰腺炎也可能出现胸腔积液，通常为左侧、性质较轻且具有自限性。然而，反复发作的胰腺炎可能导致胰胸膜瘘（PPF），表现为大量、快速复发的单侧胸腔积液。在 PPF 患者中，最常见的主诉是呼吸困难。我们报告了 1 例 53 岁男性患者，他反复发作胰腺炎，与酒精有关，表现为逐渐加重的呼吸困难。高分辨率胸部计算机断层扫描显示右侧大量胸腔积液。进行了胸腔穿刺，胸腔积液研究显示渗出性积液，淀粉酶显著升高，达到 18382U/L。进行了内镜逆行胰胆管造影术，显示胰腺尾部胰管漏。进行了胰管括约肌切开术，并在胰管腹侧放置了支架。患者的呼吸困难得到改善，出院后门诊随访。本报告的目的是介绍慢性胰腺炎罕见并发症的诊断，并讨论其治疗管理和选择。
