From the Research
The treatment of pleural effusion in pancreatitis should primarily focus on managing the underlying pancreatic inflammation while addressing the effusion itself, with the most recent and highest quality study suggesting endoscopic treatment as a first-line therapy 1. The initial management includes supportive care with oxygen supplementation, pain control, and respiratory monitoring.
- Thoracentesis is often performed for both diagnostic and therapeutic purposes, especially for large or symptomatic effusions causing respiratory distress.
- If the effusion is recurrent or large, chest tube drainage may be necessary. The underlying pancreatitis should be treated with:
- Bowel rest
- Intravenous fluids
- Pain management
- Nutritional support In cases where the effusion is directly connected to pancreatic duct disruption (pancreaticopleural fistula),
- Endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stenting may be required to reduce pancreatic duct pressure and allow healing, as shown in a study from 2.
- Octreotide (100-200 mcg subcutaneously three times daily) can be used to decrease pancreatic secretions, as suggested by a case report from 3. Antibiotics are only indicated if infection is suspected. Most pleural effusions in pancreatitis resolve with successful treatment of the underlying pancreatic inflammation, but persistent cases may require surgical intervention such as thoracoscopic decortication or, rarely, treatment of the pancreatic pathology through distal pancreatectomy or pancreatic pseudocyst drainage. The development of pleural effusion in pancreatitis occurs due to direct diaphragmatic inflammation, transdiaphragmatic lymphatic involvement, or formation of pancreaticopleural fistulas, making targeted treatment essential for resolution, as highlighted in a study from 4 and a review on pleural effusion management from 5.