Surgical management of pancreaticopleural fistula with video-assisted retroperitoneal pancreatic debridement: A case report

INTRODUCTION: Pancreaticopleural fistula is a rare complication of both acute and chronic pancreatitis. Here, we present a case of a pancreaticopleural fistula treated with Video-Assisted Retroperitoneal Debridement (VARD). CASE PRESENTATION: A 52-year-old male with a history of severe acute biliary pancreatitis presented with cough, chest pain and fever. Physical exam showed absent respiratory sounds in the right base. Chest tomography revealed a right pleural collection. The patient underwent a right thoracotomy which confirmed a pancreaticopleural fistula, and then an ERCP was performed for conservative management and the patient was discharged. The patient was re-admitted on the 27(th) postoperative day where we confirmed a superinfected pancreatic necrosis and persistence of the fistula; the patient underwent a VARD for the treatment of both conditions. The patient was discharged after completing 5 weeks of antibiotic management. DISCUSSION: The management of a pancreaticopleural fistula is based on medical and endoscopic treatment; the surgical options are reserve for cases where the conservative management have failed and when the spontaneous closure of the fistula is unlikely. In our case, conservative management for the pancreaticopleural fistula failed and the patient presented another complication of the pancreatitis, for which we decided to perform a minimally invasive resective surgery to treat both complications. CONCLUSION: This is the first case of a pancreaticopleural fistula with superinfected pancreatic necrosis managed with a video-assisted retroperitoneal pancreatic necrosectomy. This case will give surgeons another tool to treat these conditions that has less complications than other resective pancreatic surgeries and can solve both complications.