# Multispecialty Management of Pancreaticopleural Fistula With Recurrent Pleural Effusions: A Case Report and Literature Review

## TL;DR

A rare case of pancreaticopleural fistula is described, highlighting the need for early diagnosis and coordinated care to manage complex complications.

## Contribution

This case report adds to the literature on PPF by emphasizing multispecialty management and diagnostic strategies.

## Key findings

- Pleural fluid with elevated lipase levels helped confirm the diagnosis of PPF.
- Multispecialty care including endoscopic stenting and surgical interventions was critical in managing the patient's condition.
- Conservative management was chosen due to high surgical risk, showing an alternative approach for complex PPF cases.

## Abstract

Pancreaticopleural fistula (PPF) is an uncommon complication of pancreatitis that typically presents with respiratory symptoms rather than classic epigastric pain. PPF often occurs in settings of alcoholic pancreatitis with pancreatic pseudocyst rupture or ductal disruption, leading to abnormal pancreas-pleural communication.

A 50-year-old woman with alcohol and tobacco use disorders presented with progressive dyspnea. She was found to have a left pleural effusion and acute pancreatitis. She experienced recurrent admissions for persistent pleural effusions despite appropriate chest tube drainage. Pleural fluid revealed markedly elevated lipase, and serial imaging identified a pseudocyst and PPF. A disconnected pancreatic duct was endoscopically stented. Her course included management with surgical decortication, talc pleurodesis, and multiple chest tubes, as well as complications of an enlarging pancreatic pseudocyst, splenic vein thrombosis, and pleural empyema. She was declined as a surgical candidate for pancreatectomy due to high operative risk. A multidisciplinary team recommended conservative management with parenteral nutrition and fistula suppression with octreotide.

This case underscores the importance of early suspicion for PPF in patients with pancreatitis and recurrent pleural effusions, emphasizing the role of pleural enzyme testing, targeted imaging, and coordinated multispecialty management to reduce diagnostic delays and guide timely intervention.