A 74-year-old man had experienced dyspnea. Contrast-enhanced CT confirmed bilateral pleural effusion, pericardial effusion, and accumulation of 31×19 mm of fluid under the diaphragm. Due to high amylase levels in the pleural effusion fluid, a pancreatic pleural effusion was suspected. On day 15, ERCP was performed, which showed a narrowed pancreatic duct in the pancreatic body, with leakage of the contrast agent from the pancreatic body. We diagnosed pancreatic fistula and performed 5Fr ENPD. On day 21, it was replaced with a 7-Fr pancreatic duct stent ; however, the pancreatic fistula and pleural effusion showed little improvement, with increased pericardial effusion. On day 42, the stent was replaced with a 10-Fr pancreatic duct stent, and somatostatin was concurrently administered. However, infection of a pseudocyst just below the diaphragm was suspected. On day 54, we performed percutaneous drainage on the pancreatic fistula under the diaphragm. Subsequently, the pseudocyst improved.
