Chylothorax As a Rare Complication after Severe Necrotizing Pancreatitis and Endoscopic Pancreatic Necrosectomy.

A 72-year-old man was admitted with severe necrotizing pancreatitis and multiorgan failure. He was a nondrinker and was not taking medications associated with pancreatitis such as thiazide diuretics or corticosteroids. Blood tests revealed an elevated serum amylase of 2598 U/L and an elevated serum triglyceride value of 248 mg/dL (normal <150 mg/dL). Serial CT scans showed acute pancreatitis with increasing peripancreatic collections and progressive nonenhancement of the pancreas. No gallstones were present, and the cause of pancreatitis remained undetermined. Percutaneous pigtail drainage of the peripancreatic fluid was performed, and the drain track was dilated to allow for the introduction of a 9.8-mm water-jet endoscope (GIF-Q260J, Olympus, Tokyo, Japan) (A). Six sessions of endoscopic pancreatic necrosectomy were performed, during which the retroperitoneal cavity was irrigated with copious amounts of saline solution, and large amounts of turbid fluid were removed along with large pieces of necrotic pancreatic tissue (B). Culture of the necrotic tissue showed a heavy growth of Escherichia coli (C). Two weeks after the first endoscopic pancreatic necrosectomy, the patient experienced a right pleural effusion. Drainage was performed, and a milky pleural fluid was aspirated (D). The result of testing for chylomicrons was positive, thus confirming the diagnosis of chylothorax. The patient was treated conservatively by nil-per-oral, total parental nutrition, and repeated pleural drainage. Output from the pleural drain slowly diminished, and follow-up CT scan at 6 months showed resolution of the peripancreatic collection and pancreatic necrosis.