Pancreatico-pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleuralcavity, most commonly from an enlarging pseudocyst.We review the literature on the causes, investigations and treatment of pancreatico-pleural fistulaeand compare this with our own experience of the case of a 41 year old man with a left sided pancreatico-pleuralfistula associated with pancreatic duct obstruction.The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patientwas managed conservatively. However, deterioration in the patients' condition led to an urgent but notemergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreaticduct, with associated pleural fistula for which aggressive surgical intervention was indicated. Thepatient subsequently completely recovered.
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