Subphrenic and lung abscesses with bronchial fistula after acute pancreatitis. Treatment by left lung inferior lobectomy and partial resection of the left diaphragm with reconstruction using pedicled flap of the lateral dorsal muscle

Abstract

A 65-year-old woman suffered from idiopathic severe acute pancreatitis complicated with an infected pancreatic pseudocyst, which developed into subphrenic abscess and resulted in lung abscess through the diaphragmatic hiatus into the pleural cavity at about 4 months after onset. She was referred to our hospital and treated by drainage. An enhanced study via the drainage tube under fluoroscopy revealed bronchial fistula. The endoscopic retrograde pancreatography did not reveal a bronchopancreatic fistula. She recovered from the pancreatic pseudocyst following conservative therapy, but not the subphrenic abscess and lung abscess with bronchial fistula by drainage. The patient underwent inferior lobectomy of the left lung and partial resection of the left diaphragm with reconstruction of the left diaphragm using a pedicled flap of the lateral dorsal muscle. At two years after the operation, the patient remains well with no recurrence. Successful surgical treatment of subphrenic and lung abscesses associated with bronchial fistula due to an infected pancreatic pseudocyst could be achieved through a thoracic approach alone, following conservative treatment of the intra-abdominal infection.