We report the case of a 59-year-old male patient with a history of alcoholic chronic pancreatitis, admitted for respiratory failure.
After physical examination and a chest X-ray, a right pleural effusion was diagnosed.
After performing diagnostic emphasizeesis and evacuation, the patient experienced dyspnea and superior vena cava syndrome.
A second chest X-ray showed mediastinal widening.
A CT scan showed a large thoracic fluid collection with no pathological findings in the abdomen, which was drained through a chest tube.
This liquid contained a high concentration of amylase (104,000 U/ml).
A bulging area with inflammatory signs appeared in the right lateral cervical region, which was drained, from which a high concentration of amylase (90,000 U/ml) was also obtained.
After drainage of cervical and thoracic fistulae, dyspnea improved and the patient recovered.
In order to investigate the suspected pancreatic origin of fistula, ERCP was performed. It was found that the pancreatic duct of Wirsung was irregular but did not present dilatations and communicated with the pancreatic duct.
A plastic stent was placed, which closed the fistula.
The patient improved without surgery.
The stent was removed endoscopically at 3 months.
The patient was well, with no recurrence of the pseudocyst after 2 years.
