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Case Report
 
Pancreatic endotherapy in management of rare case of pancreatico-pericardial fistula post chronic pancreatitis: A case report
Vikas Pandey1, Kaivan Shah1, Nilesh Pandav1, Meghraj Ingle2, Aniruddha Phadke3, Prabha Sawant4
1Senior Resident, LTMMC & LTMGH, Sion, Mumbai 400022.
2Assistant Professor, Department of Gastroenterology, LTMMC & LTMGH, Sion, Mumbai 400022.
3Associate Professor, LTMMC & LTMGH, Sion, Mumbai 400022.
4Professor and Head of the Department, LTMMC & LTMGH, Sion, Mumbai 400022.

Article ID: 100037IJHPDVP2015
doi:10.5348/ijhpd-2015-37-CR-12

Address correspondence to:
Vikas Pandey
Senior resident, Department of Gastroenterology
Lokmanya Tilak Medical College & Sion Hospital Mumbai -22
India

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How to cite this article:
Pandey V, Shah K, Pandav N, Ingle M, Phadke A, Sawant P. Pancreatic endotherapy in management of rare case of pancreatico-pericardial fistula post chronic pancreatitis: A case report. Int J Hepatobiliary Pancreat Dis 2015;5:70–73.


Abstract
Introduction: Acute or chronic pancreatitis has been known to be associated with complications like Pseudocyst, pancreatic necrosis,splenic vein thrombosis, pancreatic ascites and pleural effusion. Rarely do we find presentation of patient with cardiac tamponade and gross pericardial effusion due to pancreaticopericardial fistula.
Case Report: We report a case of a 38-year-old male presented with chest tightness, abdominal fullness and dull aching abdominal pain. Chest X-ray was suggestive of pericardial effusion which recurred immediately. Contrast-enhanced computed tomography (CECT) scan of abdomen revealed dilated MPD (main pancreatic duct), pseudocyst in head region extending up to epigastrium and communicating with collection under dome of diagphragm and with pericardial effusion. Endoscopic retrograde cholangiopancreaticography was performed, with pancreaticogram revealed pancreatic dye leaking into posterior mediastinum and communicating -pericardial cavity thus forming an effusion. Pancreatic duct stenting with 7 Fr stent was done and patient recovered uneventfully.
Conclusion: Pancreaticopericardial fistula presenting with cardiac tamponade is a rare presentation of alcoholic chronic pancreatitis. Conventionally, surgical options in form of lateral pancreatojejunostomy is considered treatment of choice. Our case has been managed successfully by ERCP and pancreatic duct stenting which could be an effective option thus avoiding surgery.

Keywords: Endotherapy, Fistula, Pancreatico-pericardial, Pancreatitis


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Author Contributions
Vikas Pandey – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kaivan Shah – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nilesh Pandav – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Meghraj Ingle – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Aniruddha Phadke – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Prabha Sawant – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Vikas Pandey et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.