Palliative open cystogastrostomy for giant pancreatic pseudocyst in pancreatic malignancy – a rural experience

Abstract

Pancreatic pseudocysts are common sequelae of pancreatitis, but rarely occur in the context of pancreatic malignancy. Giant pseudocysts are another uncommon phenomenon and are defined as those greater than 10 centimetres in diameter. These may cause mass effect with obstructive symptoms warranting surgical intervention, which nowadays typically involves endoscopic drainage. We report a 70-year-old man presenting with gastric outlet obstruction secondary to giant pancreatic pseudocyst on the background of unresectable pancreatic ductal adenocarcinoma. In the absence of locally available specialised endoscopic services and in accordance with the patient’s preference for local care, a palliative open cystogastrostomy was performed at a rural Australian hospital. Drainage of over two litres of cyst fluid allowed for significant improvement in pain, oral intake, and vomiting at follow-up. This case describes the rare coexistence of giant pancreatic pseudocyst and pancreatic malignancy, and highlights that open cystogastrostomy remains a safe and effective option in selected patients. Patient-centred decision-making that factors in patient goals, symptom burden, and local resource availability is especially important in rural settings and life-limiting disease.