Olanzapine Induced Necrotizing Pancreatitis and Pancreatico-Pleural Fistula Mandating Robotic Pancreatectomy

Introduction: Olanzapine as a cause of necrotizing pancreatitis is very rare. Unheard of in the literature is the development of a pancreatico-pleural fistula following olanzapine induced necrotizing pancreatitis requiring minimally invasive pancreatectomy to resolve the disease. This report seeks to publish the history, findings and strategies used to resolve this extremely unique case. Case Description: A 53-year-old male presented with over a year of chronic abdominal pain. He was diagnosed with pancreatitis. His presentation worsened, leading to necrosis, peripancreatic fluid collections and ultimately a pancreatico-pleural fistula. Despite a low-fat diet, confirmation of alcohol abstinence, absence of gallstones, pancreatic duct stenting, peritoneal and pleural drainage, the fistula persisted and his weight loss worsened. Hepatobiliary surgery was consulted, performed a successful minimally invasive pancreatectomy. His drains were removed sequentially and at final follow up was free of symptoms, regaining weight. Discussion: Olanzapine as a cause of acute necrotizing pancreatitis is rare. For it to result in necrosis, peripancreatic fluid collections and a pancreatico-pleural fistula is even rarer. This case failed to resolve with nonsurgical management. Robotic technology combined with appropriate endoscopic, interventional radiologic and nutritional therapy resolved this case, highlighting strategies that will be useful to physicians and their patients, as well as being of great interest.