Junior Resident (Post Graduate - III)1, Consultant and Associate Professor2*, Professor and HOD, Consultant3, Consultant and Associate Professor4, Consultant and Assistant Professor5, Consultant, Intensivist and Assistant Professor6, Consultant and Assistant Professor7, Consultant and Senior Resident8
1,2,3,4,5,6,7,8Department of Respiratory Medicine, Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka
Background: Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis. In this condition, pancreatic secretions move across the diaphragm, causing large or recurring pleural effusions, and sometimes, secondary empyema. Spotting this issue early in patients who mainly show respiratory symptoms is vital. It helps prevent sepsis, the need for surgery, and lasting lung problems.
CASE PRESENTATION: A 36-year-old man with high blood pressure has suffered from alcohol-related recurring pancreatitis since 2019. The patient came in with two weeks of worsening breathlessness, right-sided chest pain, and abdominal pain. Upon examination, his breath sounds were reduced over the right lower lung area, indicating a possible pleural collection. A contrast-enhanced CT scan of the thorax and abdomen showed loculated right pleural effusion and acute on chronic pancreatitis, bilateral pancreaticopleural fistulous tracts. This effusion had enhancing pleura, internal air pockets, and signs of underlying atelectasis and consolidation, which suggest empyema. The patient received image-guided intercostal drainage. The pleural pus culture revealed multidrug-resistant Escherichia coli, resistant to most beta-lactams and fluoroquinolones, but sensitive to carbapenems, colistin, fosfomycin, tigecycline, aminoglycosides, trimethoprim-sulfamethoxazole, and tetracycline. Carbapenem-based antibiotics targeted to the culture results, octreotide, pancreatic enzyme supplements, and patient had undergone endoscopic retrograde cholangiopancreatography with main pancreatic duct (MPD) stenting. This treatment led to clinical improvement and complete resolution of the pleural collection on follow-up.
Keywords: Pancreaticopleural fistula; Acute on chronic pancreatitis; Loculated empyema; Multidrug-resistant Escherichia coli; Intercostal drain; Octreotide therapy.
How to cite this article: Dr. Gautam| Beyond the hemithorax: Right sided pleural effusion revealing a pancreaticopleural fistula| Int J Drug Deliv Technol. 2026;16(5s): 871-874. DOI: 10.25258/ijddt.16.5s.105
Source of support: Nil.
Conflict of interest: None