Psychosocial Issues in Inflammatory Bowel Disease and Intestinal Failure
- John E Franklin
- The American Journal of Gastroenterology
reached from the fundus of the stomach area to the diaphragm. A distal splenopancreatectomy and an adhesiolysis were performed. The postoperative course was uneventful. A pancreaticobronchial fistula may occur in patients with acute (AP) and chronic pancreatitis (CP) during artificial ventilation for an adult respiratory distress syndrome (3). In nonventilated patients, only 13 reported cases of pancreaticobronchial fistulas have been reported, nine in AP (4–10) (7 concerns two cases) and four in CP (11–14). Three respiratory conditions reported were left-sided pleural effusion in CP (11); left-sided pneumonia in AP (4); and dyspnoe, also in AP (5). Mere coughing was reported in two instances, one in AP (6) and one in CP (12). Otherwise, in most cases (seven) coughing with copious sputum was present, five in AP (7–10) and two in CP (13, 14). Sputum was frothy three times in AP (both cases from Refs. 7 and 9), once in CP (13), or clear yellow in AP (10), or sanguinolent (hemoptysis) in AP (7 [one case]) and CP (14). Ours is the first case in which a sudden cough with foul-smelling sputum was the first sign of a pancreaticobronchial fistula indicating linkage from the pancreatic pseudocyst system below and above the diaphragm to the bronchial tree.