Pancreaticopleural fistula: you can only find it if you look for it

We present a case of a 52-year-old man with chronic toxic pancreatitis and history of multiple hospital admissions secondary to pancreatitis exacerbation. Due to persistent respiratory symptoms a thoracoabdominal computerized tomography (CT) was performed. The CT showed a new significant right pleural effusion as well as inflammatory changes secondary to acute pancreatitis. Within these inflammatory changes extending towards the right diaphragmatic crura. The diagnostic thoracentesis showed an amylase level of 4000UI/L. Subsequently, given de suspicion of pancreaticopleural (PPF) fistula treatment with somatostatin 6mg/12h was initiated and endoscopic retrograde cholangiopancreatography (ERCP) was performed. The pancreatic duct could not be cannulated by CPRE so an echoendoscopy was carried out with insertion of a pancreatic stent by pancreatic rendez-vous technique. The evolution was satisfactory with resolution of the fistula.