Review on Pancreaticopleural Fistula: Unravelling a Rare Connection between the Pancreas and Pleura

A rare but serious complication of pancreatic disorders, especially chronic pancreatitis, is Pancreaticopleural Fistula (PPF). PPF is characterised by aberrant communication between the pleural cavity and the pancreatic ductal system. Diagnostic techniques such as Magnetic Resonance Cholangiopancreatography (MRCP), Computed Tomography (CT), and Endoscopic Retrograde Cholangiopancreatography (ERCP) are very important for identifying the fistulous tract and the underlying pancreatic disease. In some cases, conservative treatment with somatostatin analogues and thoracocentesis can work; however, most patients will need endoscopic or surgical treatment to close the fistula and treat the primary pancreatic disease. Endoscopic therapies, including pancreatic duct stenting, have become less invasive and more effective. Surgery is reserved for cases that do not respond to other treatments and usually involves resection or drainage of the pancreas. Despite advancements in imaging and minimally invasive techniques, PPF remains a diagnostic and therapeutic challenge due to its rarity and non specific presentation. The present review aims to comprehensively synthesise current evidence on the pathophysiology, clinical manifestations, diagnostic challenges, and management strategies of PPF.