Pancreatico-pleural fistula manifested by pain of the epigastrium

We are reporting a case of a pancreatic-pleural fistula causing epigastric pain. Chest radiograph revealed pleural effusion reaching the seventh rib. Thoracocentesis was performed and 1600 mL of brownish fluid was removed, which showed an elevated amylase level. Ultimately, the diagnosis was confirmed by computed tomography. Due to the failure of medical and endoscopic treatment, the decision was made to perform surgery. It resulted in total pancreatectomy.