RARE COMPLICATION OF THE CHRONIC PANCREATITIS

Background. Pancreaticopleural fistulas are rare, typical internal pancreatic fistulas arising most of all during an acute exacerbation of underlying chronic alcohol--associated pancreatitis. In posterior disruption of pancreatic ducts leaking pancreatic juice may track through the esophageal and aortic hiatus to the mediastinum. Methods. Clinical data of 6 patients with chronic alcohol--associated pancreatitis were analyzed in whom pancreaticopleural fistula arised always with left--sided pleural cavity. Results: In all patients we confirmed pancreaticopleural fistula with disruption of panreatic duct by means of endoscopic retrograde cholangiopancreatography (ERCP) and/or computer tomgraphy (CT) and perioperative fistulography. Visualisation of anatomy and location of pancreatic duct obstruction is important. In one patient with proximal pancreatic duct obstruction successful duodenopancreatic drainage was performed by endoscopic stent placement. Five patients were operated on after initial conservative treatment failure. In 2 patients we created latero--lateral fistulopancreaticojejunostomy Roux--en--Y. In one patient we made segmental(central) resection of the proximal part of pancreas body and termino--terminal pancreaticojejunostomy Roux--en--Y. Two patients with communicating pancreatic pseudocyst were solved by pseudocysto--gastrostomy. Postoperative course in all patients was complications free. Postoperative mortality was 0.0 %. During the follow--up after 5, 6, 7 and 9 years there was no exacerbation of pancreatitis.