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• W2977580702 abstract "Introduction: Pancreatic pseudocysts (PPC) are inflammatory fluid collections in the pancreas or peripancreatic space, and are often the complication of acute/chronic pancreatitis. PPC are usually asymptomatic, but can present with wide array of symptoms such as abdominal pain, upper gastrointestinal bleeding, nausea, vomiting, and gastric and bile duct compression leading to early satiety and jaundice. Rupture of PPC with fistula formation with the gastrointestinal tract is rare complication, with only a few cases reported in literature. Case Presentation: This is a 64-year-old female with history of cirrhosis, chronic pancreatitis, and PPC who was transferred from an outside hospital (OSH) for management of increasing size of PPC. CT abdomen at the OSH showed increased size of PPC from 45 mm to 88 mm in 6 months, resulting in gastric outlet and common bile duct obstruction. OSH records showed leukocytosis (28,100 cells/uL), alkaline phosphatase (637 U/L), total bilirubin (3 mg/dL), ALT/AST (58/82 U/L). At OSH, the patient was placed on broad spectrum antibiotics and an EUS was performed, which showed a large pseudocyst measuring 10x9 cm at the head of the pancreas, with 7x5 cm area of debris. Transdoudenal aspiration of the pseudocyst yielded debris with thick mucinous fluid; second attempt revealed bloody fluid. At our hospital, an EUS was attempted to drain the pseudocyst, which revealed necrotic PPC with a fistula connecting to the duodenum. Further evaluation revealed bloody clots and fluid filled debris within the necrotic cavity and duodenum. No drainage was attempted; it was felt that the pseudocyst would self-resolve by draining into the duodenum. Follow up CT showed decreased PPC size. The patient's symptoms improved.Figure 1Figure 2Discussion: Spontaneous rupture of PPC and fistula formation is a very rare occurrence with very few cases reported. Due to the paucity of cases in the literature, there are no clear guidelines on the management of a ruptured pseudocyst. PPC are usually treated via three main mechanisms: percutaneous drainage, surgical intervention, or endoscopic transpapillary or transmural drainage. Endoscopic drainage is the preferred method of treatment because it carries lower risk of complication, with similar rates of success as surgery. However, if the pseudocyst develops a fistula with the gastrointestinal tract, the pseudocyst can self-resolve by draining directly into the digestive tract, without intervention." @default.
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• W2977580702 date "2016-10-01" @default.
• W2977580702 modified "2023-09-25" @default.
• W2977580702 title "Management of Ruptured Pancreatic Pseudocyst with Fistulous Communication to the Duodenum" @default.
• W2977580702 doi "https://doi.org/10.14309/00000434-201610001-02577" @default.
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