A case of pancreatic-pleural fistula of Type 1 autoimmune pancreatitis successfully treated with pancreatic drainage and
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CASE REPORT
A case of pancreatic‑pleural fistula of Type 1 autoimmune pancreatitis successfully treated with pancreatic drainage and steroid Naoyuki Hasegawa1 · Yuji Yamaguchi1 · Junji Hattori1 · Masato Endo1 · Kazunori Ishige1 · Kuniaki Fukuda1 · Ichinosuke Hyodo1 · Yuji Mizokami2 Received: 18 November 2019 / Accepted: 11 April 2020 © Japanese Society of Gastroenterology 2020
Abstract Pancreatic-pleural fistula is a rare but severe complication with pancreatitis. A 50-year old man with heavy alcoholic history was transferred to our hospital due to pancreatic pleural effusion with diffuse pancreatic swelling. MRCP revealed two stenotic parts of main pancreatic duct. We inserted a pancreatic stent, and pleural effusion was improved. However, diffuse pancreatic swelling still remained for 3 months. Autoimmune pancreatitis was suspected because of morphologic appearance and high serum levels of IgG4. We confirmed his illness as Type 1 autoimmune pancreatitis pathologically by EUS-FNA and started steroid administration. Diffuse pancreatic swelling was improved immediately. Pancreatic-pleural fistula did not relapse after removing the pancreatic stent and tapering steroid. This is a first report for pancreatic-pleural fistula caused by autoimmune pancreatitis and successfully treated with pancreatic drainage and steroid. Keywords Pancreatic-pleural fistula · Autoimmune pancreatitis · Steroid · Pancreatic stent · EUS-FNA Abbreviations EUS-FNA Endoscopic ultrasonography-guided fineneedle aspiration AIP Autoimmune pancreatitis CT Computed tomography MRCP Magnetic resonance cholangiopancreatography ERCP Endoscopic retrograde cholangiopancreatography
Introduction Pancreatic-pleural fistula was mainly complicated with chronic pancreatitis due to alcoholic abuse [1–7]. Until now, we can find no reports for pancreatic-pleural fistula caused by autoimmune pancreatitis (AIP) and consider it a rare case. We experienced such a case and reported here. * Naoyuki Hasegawa naoyuki‑[email protected] 1
Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennoudai, Tsukuba, Ibaraki 305‑8575, Japan
Endoscopic Center, University of Tsukuba Hospital, 2‑1‑1 Amakubo, Tsukuba, Ibaraki 305‑8576, Japan
2
Case report A 50-year old man with left lower back pain was admitted to the local hospital. He had drunk a lot of alcohol more than 30 years, but had no severe disease history before. He had an operation to remove a spleen and left kidney due to a traffic accident 20 years ago. MRI showed fluid collection in the upper portion of left iliopsoas muscle. The orthopedist punctured the fluid, and it was dark and serous. After the puncture, the lower back pain improved, and he was discharged at once. However, 1 month later, not only the left lower back, but also pleuritic chest pain was presented. CT showed that the pancreas was diffusely swelling. Capsulelike rim was observed around the tail of pancreas (Fig. 1a), and its tail was contacting the left iliopsoas fluid (Fig. 1b, white triangle). The
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