Excision of a giant pseudo-pancreatic cyst masquerading as ascites in young patient: a case report

Authors

  • Thirugnanasambandam Nelson Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India
  • Saji Vargheese Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India
  • Satya Ranjan Patra Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India
  • Arnab Saha Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India

DOI:

https://doi.org/10.18203/2349-2902.isj20203814

Keywords:

Giant pancreatic pseudocyst, Ascites, Pancreaticojejunostomy

Abstract

Pancreatic pseudocysts are diagnosed more frequently due to increased usage of imaging techniques. A pseudocyst with diameter of 10 cm is defined as giant cyst. Larger and symptomatic pseudocysts require intervention while cysts upto 6 cm can be managed conservatively. A 16 year old young patient presented with abdominal pain, progressive abdominal distension, and breathlessness for 15 days. On examination, patient had tense distended abdomen with gross ascites. His vitals showed tachycardia, hypotension and tachypnea. After resuscitation, ultrasound showed gross ascites with moving echoes and contrast-enhanced computed tomography (CECT) abdomen showed similar findings. Patient underwent multiple therapeutic tapping of ascitic fluid but no significant improvement. Diagnostic laparoscopy showed giant pseudo pancreatic cyst extending from diaphragm to the pelvis with necrotic material. Patient underwent exploratory laparotomy, drainage of necrotic material with excision of giant pseudocyst and roux-en-y pancreaticojejunostomy. Post operatively patient had an uneventful recovery. Giant pancreatic pseudocysts are unusual and early management is required. Some experts considered external drainage is safer than cystogastrostomy. We suggest early diagnosis and surgical excision is feasible for a giant pancreatic pseudocyst. However, endoscopic drainage can be considered in some instances.

Author Biographies

Thirugnanasambandam Nelson, Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India

Assistant Professor,
Department of General Surgery,
Andaman and Nicobar Islands Institute of Medical Sciences,
Port Blair, India

 

Saji Vargheese, Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India

Senior Surgical Consultant,
Associate Professor,
Department of General Surgery,
Andaman and Nicobar Islands Institute of Medical Sciences,
Port Blair, India

Satya Ranjan Patra, Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India

Professor,
Department of General Surgery,
Andaman and Nicobar Islands Institute of Medical Sciences,
Port Blair, India

Arnab Saha, Department of General Surgery, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India

Former Senior Resident,
Department of General Surgery,
Andaman and Nicobar Islands Institute of Medical Sciences,
Port Blair, India

References

Fasanella KE, McGrath K. Cystic lesions and intraductal neoplasms of the pancreas. Best Pract Res Clin Gastroenterol. 2009;23(1):35-48.

Oria A, Ocampo C, Zandalizini H, Chiappetta L, Moran C. Internal drainage of giant acute pseudocysts: the role of video-assisted pancreatic necrosectomy. Arch Surg. 2000;135(2):136-40.

Soliani P, Franzini C, Zieglar S, Rio PD, Dell’Abate P, Piccolo D, et al. Pancreatic pseudocysts following acute pancreatitis: risk factors infuencing therapeutic outcomes. JOP. 2004;5(5):338-47.

Warshaw AL, Christison-Lagay ER. Pancreatic cystoenterostomy. In: Baker RJ, Fischer JE, editors. Mastery of surgery. 5th ed. New York: Lippincott Williams & Wilkins. 2009;1277-98.

Walker LGJ, Stone HH, Apple DG. Pseudocysts of pancreas: a review of 59 cases. South Med J. 1967;60:389-93.

Shah SA, Abdullah MT, Kakar AH, Zubair H. Giant pancreatic pseudocyst. J Coll Physicians Surg Pak. 2012;22(5):325-7.

Wang GC, Misra S. A giant pancreatic pseudocyst treated by cystogastrostomy. BMJ Case Rep. 2015.

Aghdassi AA, Mayerle J, Kraft M. Pancreatic pseudocysts- when and how to treat?. HPB (Oxford). 2006; 8:432-41.

Lerch MM, Stier A, Wahnschaffe U, Mayerle J. Pancreatic pseudocysts: observation, endoscopic drainage, or resection? Deutsches Ärzteblatt International. 2009;106:614.

Udeshika W, Herath H, Dassanayake S, Pahalagamage S, Kulatunga A : a case report of giant pancreatic pseudocyst following acute pancreatitis: experience with endoscopic internal drainage; BMC Res Notes. 2018;11:262.

Zirngibl H, Gebhardt C, FaSbender D. Drainagebehandlung von Pankreaspseudocysten. Langenbecks Arch Chir. 1983;360:29.

Parks RW, Tzovaras G, Diamond T, Rowlands BJ. Management of pancreatic pseudocysts. Ann R Coll Surg Engl. 2000;82:383-7.

Sarr MG, Aranha GV, Way LW, Houghton SG. Drainage of pancreatic pseudocysts. In atlas of upper gastrointestinal and hepato-pancreato-biliary surgery. 2007;729- 44.

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Published

2020-08-27

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Section

Case Reports