Comprehensive Postoperative Physiotherapy for Pulmonary Function, Functional Recovery and Quality of Life in a Patient with Pancreatopleural Fistula: A Rare Case Report

Published: June 1, 2026 | DOI: https://doi.org/10.7860/JCDR/2026/88109.23535

Dinkey A Mankad, G Palani Kumar, Kalpesh Satani

1. Assistant Professor, Department of Cardio Respiratory, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Vadodara, Gujarat, India. 2. Professor and Dean, Department of Neurological and Psychosomatic, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Vadodara, Gujarat, India. 3. Professor, Department of Cardio Respiratory, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Vadodara, Gujarat, India.

Correspondence
Dr. Dinkey A Mankad,
Assistant Professor, Department of Cardio Respiratory, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Piparia-391760, Vadodara, Gujarat, India.
E-mail: mankaddinkey@gmail.com

Pancreatopleural Fistula (PPF) is a rare complication of pancreatitis that occurs approximately in 0.4% of patients characterised by an abnormal communication between the pancreatic duct and the pleural cavity. Surgical intervention is often required in severe or necrotising cases. Comprehensive physiotherapeutic rehabilitation plays a vital role in PPF. A 25-year-old male patient presented to the hospital with complaints of lower abdominal pain, fever, nausea, vomiting, cough with whitish expectoration left-sided chest pain and breathlessness {Grade 4 modified Medical Research Council (mMRC)}. He had a history of alcohol consumption for the last ten years. Based on abdominal Computed Tomography (CT) scan findings, he was diagnosed with a left PPF along with left pleural effusion. The patient subsequently underwent a pancreatic necrosectomy. After obtaining informed consent, a detailed physiotherapy evaluation was conducted and a tailor-made pulmonary rehabilitation program included early mobilisation in the Intensive Care Unit (ICU), active breathing exercises, incentive spirometry, exercise training (aerobic and resisted exercises), positioning, and airway clearance techniques. mMRC Dyspnoea Scale showed improvement from Grade 4 to Grade 2. The Six-Minute Walk Distance increased from 120 meters to 350 meters and SF-36 (36-Item Short Form Survey) score improved from 20 to 36. Findings of this case report indicate that comprehensive postoperative physiotherapeutic rehabilitation is both feasible and effective and demonstrated significant improvement in pulmonary function, functional recovery, and better quality of life in the postoperative period in patients with PPF. A structured rehabilitation program can effectively prevent postsurgical complications, and improve functional recovery in such rare and complex thoraco-abdominal conditions.

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