Brooklyn Hospital Center Brooklyn, NY, United States
Jasparit Minhas, MD, Srilaxmi Gujjula, MD, Eric O. Then, MD, Praneeth Bandaru, , Madhavi Reddy, MD, FACG, Denzil Etienne, MD Brooklyn Hospital Center, Brooklyn, NY
Introduction: Intrahepatic pancreatic pseudocyst (IHPP) is a rare and abnormal collection of pancreatic fluid in the liver secondary to complications of pancreatitis. The pathophysiology is not thoroughly understood but it is likely due to the release of pancreatic juices towards the liver and the proteolytic effect of these pancreatic enzymes which erodes the liver resulting in subcapsular collection of fluid.
Case Description/Methods: A 52-year-old female with a medical history of diabetes and heart failure presented with chief complaint of worsening sharp epigastric pain radiating to the back associated with nausea and vomiting for two days. Patient was diagnosed with acute pancreatitis as evidenced clinically by characteristic epigastric pain and elevated lipase and amylase levels. She had multiple episodes of pancreatitis in the past. Right upper quadrant ultrasound showed cholelithiasis without cholecystitis and cystic collection within the liver. Subsequently a computed tomography (CT) scan of the abdomen and pelvis showed organized fluid collection in the pancreas tail and subcapsular cystic fluid collection along the left hepatic lobe, which was new from her prior imaging. Given the patient’s clinical history of chronic pancreatitis and new intrahepatic fluid collection, diagnosis of intrahepatic pancreatic pseudocyst was made. Given her leukocytosis, interventional radiology was then consulted who performed percutaneous drainage of the intrahepatic fluid. Fluid culture grew Enterococcus Gallinarum. She was started on appropriate antibiotics. The patient was then advised to undergo cholecystectomy to prevent further episodes of recurrent pancreatitis, but she refused. Once the acute issues had resolved and her white count trended down, she was discharged with close outpatient follow up by gastroenterology and surgery.
Discussion: IHPP is a rare complication of pancreatitis. It should be considered in a patient presenting with pancreatitis and a liver lesion. There are not many cases reported so management remains a challenge. Suggested treatment includes drainage via percutaneous, EUS or surgical approach. Antibiotics are recommended in patients with evidence of infection, as seen in our patient. Physicians should have a high index of clinical suspicion when dealing with a patient with similar presentation.
Figure: CT abdomen and pelvis images of the patient.
Jasparit Minhas indicated no relevant financial relationships.
Srilaxmi Gujjula indicated no relevant financial relationships.
Eric Then indicated no relevant financial relationships.
Praneeth Bandaru indicated no relevant financial relationships.
Madhavi Reddy indicated no relevant financial relationships.
Denzil Etienne indicated no relevant financial relationships.
Jasparit Minhas, MD, Srilaxmi Gujjula, MD, Eric O. Then, MD, Praneeth Bandaru, , Madhavi Reddy, MD, FACG, Denzil Etienne, MD. P1152 - Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.