Pancreatico-pleural fistula:: a rare cause of bilateral pleurisy and cardiac tamponade

Pancreatico-pleural fistula is a rare complication of chronic pancreatitis. It commonly presents with small, but recurrent, pleural effusions. Pericarditis rarely occurs in this context. We report a case presenting with bilateral large pleural effusions associated with cardiac tamponade. The diagnosis was suspected on detection of high concentration of pancreatic enzyme in the pleural fluid and was confirmed by both endoscopic retrograde pancreatography and magnetic resonance pancreatography. Both examinations demonstrated a fistula and a calculus of the Wirsung duct. In addition, they identified a pancreas divisum, a congenital abnormality which can rarely lead to complications. The usual medical and endoscopic management of this condition failed and a surgical solution for the fistula was needed. This case is unique due to the dramatic presentation of this complication of pancreas divisum and to the complexity of treatment required.