1.Recurrent massive bloody pleural effusion caused by pancreatic pleural fistula in a case.
Hui-min LI ; Shun-ying ZHAO ; Jin ZHOU ; Qi ZENG ; Jin-jin ZENG ; Zai-fang JIANG
Chinese Journal of Pediatrics 2009;47(8):621-623
OBJECTIVETo introduce the early clinical features and the main points of diagnosis and treatment of children with pancreatic pleural fistula presenting massive bloody pleural effusion.
METHODThe clinical data of symptoms, signs, laboratory examination, diagnosis and treatment methods of pancreatic pleural fistula in a child are presented.
RESULTA 4-year-old boy presented with one month history of intermittent fever, cough, chest tightness and chest pain. His pleural effusion collected from three thoracic closed drainage was hemorrhagic. He had no positive abdominal signs. His abdominal B-mode ultrasonography showed rough pancreatic echo. The levels of amylase in blood and pleural fluid were 495 U/L and 35 938 U/L, respectively. There was a fistulous tract from the thoracic cavity leading to the pancreas at thoracic surgical exploration. The child was cured by total parenteral nutrition, intravenous infusion of somatostatin and a stent placed in the pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP).
CONCLUSIONThe child with pancreatic pleural fistula in early stage mainly present respiratory symptoms and lack abdominal symptoms, so the diagnosis and treatment is often delayed. Significant increase of pancreatic amylase level in pleural effusion can be an important clue and basis for the diagnosis. If conservative therapy fails, the examination and treatment with ERCP should be considered.
Child, Preschool ; Humans ; Male ; Pancreatic Fistula ; complications ; diagnosis ; therapy ; Pleural Effusion ; diagnosis ; etiology ; therapy ; Recurrence
2.A Case of Pancreaticoportal Fistula Associated with Acute Severe Pancreatitis.
Young Sun YEO ; Myung Hwan KIM ; Mi Hyun YU ; Young Ju JUNG ; Soon Joo KIM ; Jae Ho BYUN
The Korean Journal of Gastroenterology 2005;46(6):485-488
Pancreatic fistulas are usually caused by the disruption of pancreatic duct. The majority of pancreatic fistulas are external fistulas and common causes of external and internal pancreatic fistulas are trauma and surgery. Internal pancreatic fistulas due to pancreatitis are rare. Internal pancreatic fistulas may communicate with peritoneal cavity, colon, small bowel, biliary system or pleural cavity. Among them, fistula between pancreatic duct and portal vein due to acute pancreatitis is rare. We report a case of 32-year-old male with fistula between pancreatic duct and portal vein as a complication of acute pancreatitis. Pancreaticoportal fistula was diagnosed by endoscopic retrograde cholangiopancreatography. He recovered after distal pancreatectomy with splenectomy and supportive care.
Acute Disease
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Adult
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Cholangiopancreatography, Endoscopic Retrograde
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English Abstract
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Humans
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Male
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Pancreatic Fistula/diagnosis/*etiology
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Pancreatitis/*complications
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*Portal Vein
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Vascular Fistula/diagnosis/*etiology
3.Pancreatic fistula may be an important complication following spleen-preserving radical gastrectomy with dissection of No. 10 and No. 11 lymph nodes.
Jun ZHANG ; Zhong-tao ZHANG ; Yu WANG ; Kang-li WANG
Chinese Medical Journal 2010;123(15):2135-2137
Adult
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Aged
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Female
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Gastrectomy
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adverse effects
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Humans
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Lymph Nodes
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surgery
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Male
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Middle Aged
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Pancreatic Fistula
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diagnosis
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etiology
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Postoperative Complications
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diagnosis
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etiology
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Spleen
4.Two Cases of Portal Annular Pancreas.
Ji Young JANG ; Young Eun CHUNG ; Chang Moo KANG ; Sung Hoon CHOI ; Ho Kyoung HWANG ; Woo Jung LEE
The Korean Journal of Gastroenterology 2012;60(1):52-55
Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Adenocarcinoma, Mucinous/diagnosis/surgery
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Aged
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Female
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Humans
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Male
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Mesenteric Veins/radiography
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Pancreas/abnormalities
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Pancreatic Diseases/*diagnosis/therapy
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Pancreatic Fistula/etiology
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Pancreatic Neoplasms/diagnosis/surgery
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Pancreaticoduodenectomy/adverse effects
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Portal Vein/radiography
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Splenic Vein/radiography
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Tomography, X-Ray Computed