Correia João, Pinho Rolando, Francisco Elsa, Proença Luísa, Fernandes Carlos, Oliveira Manuel
Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal.
General Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal.
GE Port J Gastroenterol. 2021 Sep 1;29(5):352-355. doi: 10.1159/000518447. eCollection 2022 Sep.
A 61-year-old man was diagnosed with an exudative pleural effusion with raised amylase and bilirubin levels. The patient had no previous history of acute pancreatitis or trauma and no clinical or radiological signs of chronic pancreatitis. On thoracoabdominal computed tomography, a pancreatic pseudocyst with a pancreaticopleural fistula was identified. Endoscopic retrograde cholangiopancreatography identified a ductal disruption site in the body of the pancreas. Pancreatic sphincterotomy and stent placement in the duct of Wirsung, combined with medical management, allowed fistula closure, pseudocyst reabsorption, and no relapse of the pleural effusion. The relevance of this case lies not only in its rarity but also as it highlights the importance of a multidisciplinary approach in such uncommon conditions. Optimal management of this condition is debatable due to the absence of prospective studies comparing medical, endoscopic, and surgical approaches.
一名61岁男性被诊断为渗出性胸腔积液，淀粉酶和胆红素水平升高。该患者既往无急性胰腺炎或外伤史，也无慢性胰腺炎的临床或影像学征象。在胸腹计算机断层扫描中，发现一个伴有胰胸膜瘘的胰腺假性囊肿。内镜逆行胰胆管造影确定了胰腺体部的导管破裂部位。在胰管进行胰腺括约肌切开术和支架置入，并结合药物治疗，使瘘管闭合、假性囊肿吸收，胸腔积液未复发。该病例的意义不仅在于其罕见性，还在于它凸显了在这种罕见情况下多学科方法的重要性。由于缺乏比较药物、内镜和手术方法的前瞻性研究，这种情况的最佳治疗方法存在争议。
