Pancreatic endotherapy in management of rare case of pancreatico-pericardial fistula post chronic pancreatitis: A case report

Introduction: Acute or chronic pancreatitis has been known to be associated with complications like Pseudocyst, pancreatic necrosis, splenic vein thrombosis, pancreatic ascites and pleural effusion. Rarely do we find presentation of patient with cardiac tamponade and gross pericardial effusion due to pancreaticopericardial fistula. Case Report: We report a case of a 38-year-old male presented with chest tightness, abdominal fullness and dull aching abdominal pain. Chest X-ray was suggestive of pericardial effusion which recurred immediately. Contrast-enhanced computed tomography (CECT) scan of abdomen revealed dilated MPD (main pancreatic duct), pseudocyst in head region extending up to epigastrium and communicating with collection under dome of diagphragm and with pericardial effusion. Endoscopic retrograde cholangiopancreaticography was performed, with pancreaticogram revealed pancreatic dye leaking into posterior mediastinum and communicating -pericardial cavity thus forming an effusion. Pancreatic duct stenting with 7 Fr stent was done and patient recovered uneventfully. Conclusion: Pancreaticopericardial fistula presenting with cardiac tamponade is a rare presentation of alcoholic chronic pancreatitis. Conventionally, surgical options in form of lateral pancreatojejunostomy is considered treatment of choice. Our case has been managed successfully by ERCP and pancreatic duct stenting which could be an effective option thus avoiding surgery.