Pancreaticopleural Fistula After Cytoreductive Surgery and HIPEC for Pseudomyxoma Peritonei—a Rare Presentation and Rare Complication

Excerpt

Cytoreductive surgery and hyperythermic intraperitoneal chemotherapy (HIPEC) is complex procedure with varying rates of morbidity and mortality. Pulmonary and gastrointestinal complications are the commonest causes of morbidity and mortality after cytoreductive surgery (CRS) and HIPEC. Pancreatic fistulae (PF) after CRS and HIPEC are not uncommon and together with other gastrointestinal complications like anastomotic leaks and bowel fistulae significantly contribute to morbidity and mortality. Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis or pancreatic surgeries, occurring in less than 1% of patients [1]. Diagnosis requires a high index of clinical suspicion as patients typically present with pulmonary symptoms related to the pleural effusion rather than abdominal complaints. It may develop following an unrecogonized pancreatic fistula in an asymptomatic patient. Diagnosis is confirmed by demonstrating high levels of amylase in the pleural fluid [1‐4]. …