Letters To The Editor
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World J Gastroenterol. Aug 28, 2011; 17(32): 3759-3760
Published online Aug 28, 2011. doi: 10.3748/wjg.v17.i32.3759
Role of diaphragm in pancreaticopleural fistula
Anestis P Ninos, Stephanos K Pierrakakis
Anestis P Ninos, Consultant General Surgeon, Department of Surgery, Thriassio General Hospital, Athens 19018, Greece
Stephanos K Pierrakakis, Consultant General and Thoracic Surgeon, Head of the Department of Surgery, Thriassio General Hospital, Athens 19018, Greece
Author contributions: Ninos AP and Pierrakakis SK analyzed the data and wrote the paper.
Correspondence to: Anestis P Ninos, MD, FRCSEd, Consultant General Surgeon, Department of Surgery, Thriassio General Hospital, Leoforos Genimata, Magoula, Athens 19018, Greece. apninos@gmail.com
Telephone: +30-210-5756832 Fax: +30-210-5534317
Received: January 21, 2011
Revised: March 1, 2011
Accepted: March 8, 2011
Published online: August 28, 2011
Abstract

A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic “stomata” does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.

Keywords: Fistula; Pleural effusion; Pancreatic surgery