Multispecialty Management of Pancreaticopleural Fistula With Recurrent Pleural Effusions: A Case Report and Literature Review

Pancreaticopleural fistula (PPF) is an uncommon complication of pancreatitis that typically presents with respiratory symptoms rather than classic epigastric pain. PPF often occurs in settings of alcoholic pancreatitis with pancreatic pseudocyst rupture or ductal disruption, leading to abnormal pancreas-pleural communication. A 50-year-old woman with alcohol and tobacco use disorders presented with progressive dyspnea. She was found to have a left pleural effusion and acute pancreatitis. She experienced recurrent admissions for persistent pleural effusions despite appropriate chest tube drainage. Pleural fluid revealed markedly elevated lipase, and serial imaging identified a pseudocyst and PPF. A disconnected pancreatic duct was endoscopically stented. Her course included management with surgical decortication, talc pleurodesis, and multiple chest tubes, as well as complications of an enlarging pancreatic pseudocyst, splenic vein thrombosis, and pleural empyema. She was declined as a surgical candidate for pancreatectomy due to high operative risk. A multidisciplinary team recommended conservative management with parenteral nutrition and fistula suppression with octreotide. This case underscores the importance of early suspicion for PPF in patients with pancreatitis and recurrent pleural effusions, emphasizing the role of pleural enzyme testing, targeted imaging, and coordinated multispecialty management to reduce diagnostic delays and guide timely intervention.