2014 Volume 21 Issue 6 Pages 639-643
A case in which somatostatin analogue was effective in treating massive pleural and pericardial effusion secondary to alcohol-induced chronic pancreatitis is reported. A patient with alcohol-induced chronic pancreatitis and cirrhosis consulted his family physician for epigastric pain and poor appetite and was diagnosed with acute exacerbation of chronic pancreatitis. Thereafter, he was admitted to our hospital for further treatment. On admission, the calculated severity assessment score of acute pancreatitis according to the Japanese criteria was 2 prognostic points, while contrast-enhanced CT revealed grade 1 disease. Hence, we started ordinary therapy for acute pancreatitis. However, since the patient experienced aggravation of dyspnea due to accumulation of a large amount of pleural and abdominal fluids, he was moved to the ICU on the fifth day after onset of symptoms. Chest X-ray revealed a huge pleural effusion and echocardiography showed a large amount of pericardial fluid. The exudative pleural and pericardial fluid contained very high levels of amylase (70,000 IU/l), suggesting the existence of a pancreatic fistula. On the 16th day after symptom onset, we commenced continuous subcutaneous administration of somatostatin analogue. One week after administration, with decreasing pleural and pericardial fluids, his general condition improved. Diagnosis of the cause of pleural and pericardial exudate in this patient was difficult. However, the high level of amylase in pericardial fluid, and its decrease with administration of somatostatin analogue, led us to conclude that pancreaticopericardial fistula was the cause of the pericardial effusion in this case. The administration of somatostatin analogue seems to be effective in patients with pancreatic fistulas.