P1139 - A Radiological Presentation and Surgical Excision of a 2-Year-Old-Male With Pancreatic Pseudocyst: A Case Report From a Low and Middle Income Country

Sidra Naz, MBBS¹, Zouina Sarfraz, MBBS², Vikash Jaiswal, MD³, Jon Quinonez, DO⁴, Omoyeme Edaki, MD⁴, Azza Sarfraz, MBBS⁵, Akash Jaiswal, MD^6
1University of Health Science, Lahore, Punjab, Pakistan; ²Fatima Jinnah Medical University, Peshawar, Islamabad, Pakistan; ³AMA School of Medicine, Jaunpur, Uttar Pradesh, India; ⁴Larkin Health System, Miami, FL; ⁵Aga Khan University, Karachi, Sindh, Pakistan; ⁶All India Institute of Medical Sciences, South Delhi, Delhi, India

Introduction: While pseudocysts of the pancreases are not rare, spontaneous perforation or fistulization are
noted in less than 3% of cases. The spontaneous rupture of pancreatic pseudocysts may occur in
the bronchial treat, biliary tract, colon, duodenum, renal system, and stomach. Spontaneous
ruptures associated with life-threatening symptoms necessitate surgical intervention. This
vignette highlights a case of a 2-year-old male who presented to a tertiary hospital in a low and
middle-income country (LMIC) with recurrent episodes of vomiting, fever, increased frequency
of watery diarrhea. The findings are relevant to scientific literature as the case provides value to
management options of pancreatic pseudocysts in LMICs.

Case Description/Methods: We present a case of the 2-year-old-male who had pyrexia of unknown origin, decreased
nutritional intake, and recurrent episodes of vomiting spanning one month. While OTC

medications curbed initial symptoms, the patient’s condition worsened in the past 15 days, when
vomiting frequency increased, along with water diarrhea, nausea and high-grade fever. The
patient’s weight was 10.5 kg on admission, pulse=110 bpm, BP=115/85 mm Hg, RR=40/min,
temp=102.5 °C. Due to acute distress, Focused Assessment with Sonography in Trauma (FAST)
was conducted (Fig 1a), which revealed abdominal distention with a palpable epigastric mass.
Post-conservative treatment for 1 week with IV fluids, IV ampicillin, IV dextrose saline, and
calcium supplementation, a CT scan of the abdomen located a large cystic area in the lesser sac
region behind the patient’s stomach with both intra and extrahepatic cholestasis and a right
inguinal hernia (Fig 1b). On consulting the general surgery team, the patient underwent operative
excision of the pseudocyst. Prior to surgery, FAST revealed an 11.7 x 8.8 x 10.5 cm pancreatic
pseudocyst containing 577 mL of free fluid inside a wall with a thickness of 6.4 mm. No adverse
outcomes were noted post 1 week of surgery and the patient was discharged.

Discussion: As part of standard care plans for pancreatic pseudocysts, surgical interventions must be delayed
for at least 6 weeks, following which drainage or open surgery may be conducted to reduce
morbidity and mortality. In many cases, pancreatic pseudocysts may be the only clinical
manifestation without any episodes of acute pancreatitis. The case of the male with a pancreatic
pseudocyst raises concerns for LMICs due to limited diagnostic radiology and intervention tools.


Figure: Figure 1. Radiological findings of the patient.
1a (left): USG findings on admission, 1b (right): CT Scan of the Abdomen (post one-week
of conservative treatment).

Table: Table 1. Laboratory findings of the patient during hospital stay.
WBC – White blood cell, Hgb – Hemoglobin, MCV – Mean Corpuscular Volume, Plt – Platelet, Na – sodium, K – potassium, Cl – chlorine, Cr – creatinine, Ca – Calcium.



Disclosures:
Sidra Naz indicated no relevant financial relationships.
Zouina Sarfraz indicated no relevant financial relationships.
Vikash Jaiswal indicated no relevant financial relationships.
Jon Quinonez indicated no relevant financial relationships.
Omoyeme Edaki indicated no relevant financial relationships.
Azza Sarfraz indicated no relevant financial relationships.
Akash Jaiswal indicated no relevant financial relationships.


Sidra Naz, MBBS¹, Zouina Sarfraz, MBBS², Vikash Jaiswal, MD³, Jon Quinonez, DO⁴, Omoyeme Edaki, MD⁴, Azza Sarfraz, MBBS⁵, Akash Jaiswal, MD⁶. P1139 - A Radiological Presentation and Surgical Excision of a 2-Year-Old-Male With Pancreatic Pseudocyst: A Case Report From a Low and Middle Income Country, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.