• Tauseef Ali, Nandakumar Srinivasan, Vu Le, A Rao Chimpiri, and William M Tierney.
• Departments of Internal Medicine-Section of Digestive Disease, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73013, USA. Tauseef-ali@ouhsc.edu
• Pancreas. 2009 Jan 1;38(1):e26-31.

ObjectivesPancreaticopleural fistula (PPF) is an unusual complication of chronic pancreatitis. Its diagnosis is obscured by predominance of pulmonary symptoms. A review of clinical presentation, etiology, diagnostic, and treatment modalities is presented in context of 2 cases from our institution.MethodsCase reports and case series of PPFs in the English literature from 1960 to 2007 were identified in the PubMed, OVID, and EMBASE search engines.ResultsFifty-two cases of PPF were identified. Common presenting complaint was dyspnea (65%) followed by abdominal pain (29%), cough (27%) and chest pain (23%). Computed tomography scanning diagnosed PPF in 8 (47%) of 17 patients, endoscopic retrograde cholangiopancreatography diagnosed PPF in 25 (78%) of 32 patients, and magnetic resonance cholangiopancreatography diagnosed PPF in 8 (80%) of 10 patients. Twenty-one patients (65%) improved with conservative management alone. Interventional therapy (5 endoscopic and 6 surgical interventions) was eventually needed in 35% of the patients after failing conservative management.ConclusionsPancreaticopleural fistula is a rare finding and requires a high index of suspicion for patients presenting with chest symptoms or pleural effusion and with history of pancreatitis or alcoholism. Magnetic resonance cholangiopancreatography is the better initial choice for being a noninvasive procedure and for better demonstration of complete main pancreatic duct obstruction. Restoring anatomic continuity is important if conservative approach fails.

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