Chronic pancreatitis complicated by pancreatic pleural fistula leading to black pleural effusion: a case report

Background Pancreaticopleural fistula, a rare but serious complication of chronic pancreatitis, typically presents with recurrent massive hemorrhagic pleural effusion. Respiratory symptoms dominate the clinical picture, while abdominal signs are often subtle. Case presentation A 43-year-old male was admitted with a 5-day history of chest tightness. Chest CT revealed massive left pleural effusion, and closed thoracic drainage yielded large amounts of black pleural fluid. Routine biochemical, cytological, and microbiological tests of the effusion failed to identify the cause. Given the patient’s history of alcohol abuse and chronic abdominal distension, an abdominal CT was performed, showing atrophy and multiple calcifications in the body and tail of the pancreas. Serum and pleural fluid amylase levels were measured at 354 U/L and >6000 U/L, respectively. Contrast-enhanced upper abdominal CT and MRCP further demonstrated a fistula extending from the pancreas to the left pleural cavity. The patient was diagnosed with chronic pancreatitis, pancreaticopleural fistula, and pancreatic-related pleural effusion. Following multidisciplinary consultation between gastroenterology and gastrointestinal surgery, treatment included continued closed thoracic drainage, parenteral nutrition, intravenous somatostatin, and omeprazole for enzyme and acid suppression. The patient’s condition improved significantly. Conclusions Patients with chronic pancreatitis complicated by pancreaticopleural fistula may present predominantly with respiratory symptoms and lack significant abdominal manifestations, which can lead to missed or delayed diagnosis. A markedly elevated amylase level in pleural fluid serves as a crucial diagnostic clue. Confirmation of pancreaticopleural fistula can be achieved through upper abdominal imaging evaluation.