Case Report
Pancreaticopericardial Fistula:
A Case Report and Literature Review
Muhammad S. Khan,
1
Najmi Shahbaz,
2
Hassaan A. Zia,
3
Muhammad Hamza,
2
Henna Iqbal,
2
and Ahmed Awab
1
1
Section of Pulmonary & Critical Care Medicine, University of Oklahoma Health Sciences Center, No. WP1310,
920 Stanton L Young Boulevard, Oklahoma City, OK 73117, USA
2
Dow University of Health Sciences, Mission Road, Karachi 74200, Pakistan
3
Department of Internal Medicine, University of Oklahoma Health Sciences Center, No. WP1310, 920 Stanton L Young Boulevard,
Oklahoma City, OK 73117, USA
Correspondence should be addressed to Muhammad S. Khan; muhammad-khan@ouhsc.edu
Received 17 February 2016; Accepted 20 March 2016
Academic Editor: Kurt Lenz
Copyright © 2016 Muhammad S. Khan et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Purpose. Pancreaticopericardial fstula (PPF) is an extremely rare complication of acute or chronic pancreatitis. Tis paper presents
a rare case of PPF and provides systematic review of existing cases from 1970 to 2014. Methods. A PubMed search using key words
was performed for all the cases of PPF from January 1970 to December 2014. Fourteen cases were included in the study. Te cases
were reviewed for demographic characteristics, diagnostic modalities, and treatment. Descriptive analysis of these variables was
performed. Results. Median age was 43 years. 78% were known alcoholics and 73.3% had chronic pancreatitis. Dyspnea was present
in 78%. Cardiac tamponade was present in 53%; 75% of patients had known chronic pancreatitis (RR = 0.74). Surgery was associated
with best treatment outcomes and 50% of patients who underwent endoscopic treatment survived. Conclusion. PPF is a rare disease.
Tis paper indicates that acute cardiac tamponade in patients with history of alcoholism and chronic pancreatitis could be a sign
of an existing pancreaticopericardial fstula and early surgical intervention could be life-saving.
1. Introduction
Pancreatic pseudocyst is a known complication of pancreati-
tis. Persistent leakage of pancreatic secretions can result in
development of internal fstula due to spontaneous erosion
into neighboring hollow viscus and cavities. Leakage from
pancreatic secretions can cause signifcant morbidity due
to malnutrition and infections. A fstula from pancreatic
pseudocyst to pericardium is a rare complication and can
present with cardiac tamponade. In this paper we describe a
case of pancreaticopericardial fstula and review similar cases
from 1970 to 2014.
2. Case
A middle-aged African American male presented to hos-
pital with complaints of shortness of breath and feeling of
dizziness for 3 days. Patient had known history of alco-
holism and was admitted at a rehabilitation center 3 weeks
before presentation for an elective detoxifcation. His initial
course at rehabilitation center was uneventful; however, 3
days before presentation he started feeling dizzy and had
gradual onset dyspnea on exertion that progressed to resting
dyspnea. Tis was associated with sharp 3/10 epigastric pain
radiating to his chest and back, which was aggravated by
deep breaths. His past medical history was also signifcant
for hypertension and episodes of delirium tremens. On
admission his temperature was 37 degrees Celsius and blood
pressure (BP) was 96/48 mmHg afer 2-liter fuid bolus in
emergency department, with pulse of 110/min, respiratory
rate of 20/min, and oxygen saturation of 96% on 2 L nasal
cannula. Examination was signifcant for decreased breath
sounds in lung bases, increased vocal fremitus in lef lower
lobe, and dullness to percussion at lung bases bilaterally.
Hindawi Publishing Corporation
Case Reports in Critical Care
Volume 2016, Article ID 7169341, 6 pages
http://dx.doi.org/10.1155/2016/7169341