A case of recurrent pancreaticopleural effusion is presented. The pleural effusion with high enzyme and protein contents resulted from a pancreatic internal fistula to the left pleural cavity. A sinus tract passing through esophageal hiatus was demonstrated by the endoscopic retrograde pancreatography (ERP). Surgical intervention afforded complete relief of abdominal pain and elimination of the pleural effusion.

Fistula↗

PubMed1978

Pancreatic excretion test and barrier hypothesis in progression of chronic pancreatitis.

Simultaneous data of the pancreozymin-secretin test and the pancreatic excretion test with 5,5-dimethyl-2,4-oxazolidinedione DMO) were reported for 50 patients with chronic pancreatitis. The pancreozymin-secretin test was abnormal in 90% of the patients, while the pancreatic DMO excretion test showed abnormality in 100% of the patients. The dynamic process of pancreatic excretory dysfunction is discussed. Over 60% of patients with low to moderate grade chronic pancreatitis showed a discordant pattern of decreased DMO output with normal bicarbonate concentration or normal volume flow. Approximately 96% of patients with advanced grade chronic pancreatitis had a excretory pattern of decreased DMO output with low bicarbonate concentration and decreased volume flow. These findings may further develop a barrier hypothesis in chronic pancreatitis. In the early stage of chronic pancreatitis, when functional capacity of the duct is preserved fairly well, the extraductal barrier to the rapid DMO diffusion into the ducts (diffusion barrier) may be primarily responsible for impaired pancreatic DMO excretion. With progression of chronic pancreatitis, the intraductal barrier (outflow barrier) may become pronounced and precipitate pancreatic excretory dysfunction for DMO. The concept of pancreatic barriers may well serve to systematize major histologic alterations observed in chronic pancreatitis.

Adult↗

PubMed1977

Pancreatolithiasis and pancreatic carcinoma. Evaluation of pancreatic excretion test with 5,5-dimethyl-2,4-oxazolidinedione.

The pancreatic excretion test with a weak acid of 5, 5-dimethyl-2,4-oxazolidinedione (DMO) was performed concomitantly with the pancreozymin-secretin test in 28 patients with pancreatolithiasis, 14 patients with pancreatic carcinoma, and 67 healthy subjects. The DMO concentration and total output of duodenal content after secretin stimulation, when corrected to the simultaneously determined plasma DMO concentration, were significantly reduced in the patients. While the pancreozymin-secretin test was abnormal in 96% of patients with pancreatolithiasis and in 86% of those with pancreatic carcinoma, the pancreatic DMO excretion test gave abnormal results in 100% of the patients. This suggests that the new test may well become effective in detecting early stages of pancreatic disease including carcinoma and chronic pancreatitis.

Calculi↗

PubMed1977