Massive pleural effusion from pancreaticopleural fistula: Successfully managed with endoscopic pancreatic duct stenting

We report a case of massive left sided hemorrhagic effusion secondary to pancreaticopleural fistula (PPF) in a young, previously healthy female of 17 years. High pleural fluid amylase levels prompted us for evaluation of this uncommon cause. Computed tomography (CT) of thorax and abdomen and magnetic resonance cholangio-pancreatography (MRCP) confirmed the diagnosis of PPF. Patient was managed with intercostal drainage of pleural effusion and therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) with stenting of the pancreatic duct. Patient recovered completely and is doing well after one year of follow up without any recurrence of pleual effusion. Thus, high index of suspicion, and measurement of pleural fluid amylase, especially in large and or recurrent (left sided) pleural effusions, will help in early and definitive diagnosis of PPF. Above approach with therapeutic ERCP would cure this condition with less morbidity. Advances in the latter techniques dramatically reduced the need for surgical interventions and prolonged hospital stay with conservative treatment approach.