Pancreatic Pleural Fistula (PPF) is a rare complication of acute pancreatitis, chronic pancreatitis or pancreatic pseudocyst in adults. Pancreatic cysts have not been reported to cause PPF. PPF is excessively rare in children and the diagnosis is often delayed as a result of the misleading clinical presentation. We report a toddler suffering from recurrent bloody pleural effusion caused by PPF with a pancreatic cyst. Symptoms recurred frequently when he was given conservative therapy. He was finally cured by cyst jejunum Roux-y anastomosis because the cyst was intimately adherent to the surrounding structures. We recommend that pediatricians should not disregard PPF in patients with bloody pleural effusion even if there are no abdominal symptoms. Early surgical treatment should be considered when conservative treatment fails.