Serendipitous Dramatic Resolution of a Large Infected Pancreatic Pseudocyst through a Pancreaticopleural Fistula after Acute Pancreatitis: Case Report and Review of Literature

Acute pancreatitis is a common clinical condition with a wide spectrum of local and systemic complications. Pancreaticopleural fistula (PPF) is a rare thoracic complication, more frequently associated with chronic pancreatitis and only infrequently reported following acute pancreatitis. We report a unique case of a 21-year-old female with alcohol-induced acute pancreatitis who developed infected walled-off necrosis (WON), complicated by a pancreaticopleural fistula just prior to planned surgical necrosectomy. We managed the condition with intercostal drainage and conservative therapy, resulting in complete clinical and radiological resolution without surgery. This case highlights an unusual mechanism of spontaneous internal drainage of infected necrosis into the pleural cavity, leading to clinical improvement and avoidance of major surgery. We also present a brief literature review.