Pancreatopleural fistula.

The clinical, diagnostic, and therapeutic aspects of 27 patients with pancreatopleural fistula (PPF) reported in the literature, and two additional patients managed by the authors, form the basis of this report. The diagnosis of PPF is based on the triad of massive pleural effusions, elevated pleural fluid amylase, and protein levels. PPF is a complication of chronic fibrocalcific pancreatitis in most cases. It may develop as a consequence of disruption of a dilated obstructed pancreatic duct. Pseudocysts are involved in the process in at least half of reported cases. A substantial number of PPF will close spontaneously utilizing conservative measures including pancreatic rest, total parenteral nutrition, and repeated thoracentesis. Surgical correction of the underlying pancreatic disease, including ductal decompression and drainage or resection of associated pseudocysts, is indicated to prevent recurrence of the fistula and to avoid other complications of advanced chronic pancreatitis. Associated terminal biliary obstruction should be identified and managed with biliary-enteric bypass.