Shawn Philip, DO1, Omar Tageldin, MD2, Stephen Hasak, MD2 1Albany Medical Center, Westbury, NY; 2Albany Medical Center, Albany, NY
Introduction: Pancreatic pseudocysts are encapsulated collections of homogenous fluid that are a complication of pancreatitis and most resolve on their own. However, with worsening symptoms these patients may require percutaneous or endoscopic drainage and occasionally, surgical debridement. We report a case of a pancreatic pseudocyst that resolved after drainage with stent placement but reoccurred after six months due to pancreatic duct leakage.
Case Description/Methods: We describe a case of a 54 y/o male with past medical history of alcohol abuse and hypertension that was previously discharged one month ago and completed ten days of antibiotics for alcohol induced necrotizing pancreatitis. Patient presented on this admission with cramping, non-radiating epigastric pain. Labs showed leukocytosis and elevated lipase. Computed tomography (CT) of the abdomen/pelvis showed a large pancreatic body pseudocyst without fluid collection. Patient was given intravenous (IV) antibiotics and underwent placement of a percutaneous drainage catheter to a paracolic gutter collection. He then underwent EUS revealing the pancreatic body pseudocyst measuring 11x10 cm in diameter. A needle was passed using a trans-gastric approach and an access lumen opposing metal stent was placed with a cystogastrostomy. He had improvement in abdominal pain. Aspirate was negative for infection but showed amylase level of 20,116 U/L and normal carcinogenic embryonic antigen (CEA) levels. He was discharged on oral antibiotics and his stent was removed two months later with repeat CT showing a collapsed cyst cavity with resolution of symptoms. Six months later the patient returned with abdominal pain and endorsed abstinence from alcohol. Imaging revealed reoccurrence of the pseudocyst in the same location. Repeat EUS with endoscopic retrograde cholangiopancreatography (ERCP) revealed a pancreatic duct disruption in the neck that was treated with pancreatic sphincterotomy. A plastic stent with two external flaps and single internal flap was placed in the ventral pancreatic duct. A lumen opposing stent was also placed again with a cystogastrostomy. The patient was scheduled for outpatient follow up and imaging with improvement in symptoms.
Discussion: Despite complete resolution, patients still have a risk of recurrence of pancreatic pseudocyst even up to six months. Endoscopic intervention may be more effective than drainage placement. Sphincterotomy with cystogastrostomy may prove efficacious in the treatment of recurrent pancreatic pseudocysts.
Figure: Endoscopic ultrasound revealing pancreatic body pseudocyst measuring 11x10 cm in diameter.
Shawn Philip indicated no relevant financial relationships.
Omar Tageldin indicated no relevant financial relationships.
Stephen Hasak indicated no relevant financial relationships.
Shawn Philip, DO1, Omar Tageldin, MD2, Stephen Hasak, MD2. P1141 - Recurrent Superficial Pancreatic Pseudocyst With Pancreatic Duct Leakage After Successful Cystogastrostomy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.