Nova Southeastern University, Palmetto Hospital Miramar, FL, United States
annabelle Alvarez, DO1, Natalie Donn, DO1, Melissa Matheus, MD1, Emmanuel A. McDonald, DO2, Jose Paz, DO1 1Nova Southeastern University, Palmetto Hospital, Hialeah, FL; 2Larkin Community Hospital, South Miami, FL
Introduction: Acute pancreatic pseudocysts are encapsulated fluid collections lined by fibrosed granulation tissue with minimal to no necrosis that commonly occur after 4-6 weeks of an acute pancreatitis episode. Additionally, it has been reflected as a complication of pancreatic traumas and exacerbations of chronic pancreatitis. While this is a common complication; few cases of giant pancreatic pseudocysts, greater than or equal to 10 cm in widest diameter, have been documented.
Case Description/Methods: Our patient is a 69 year old female with a past medical history of breast cancer who presented with abdominal pain and nonbilious vomiting. Patient was septic; and upon clinical assessment and imaging, was diagnosed with ascending cholangitis. Prompt ERCP was unsuccessful due to difficulty in advancing the wire into the common bile duct (CBD). Patient underwent multiple interventional radiological procedures (IR) to alleviate CBD obstruction and aid in biliary drainage. She expectedly developed severe pancreatitis. She had a waxing and waning clinical course with an episode of abdominal pain and flank pain. Two weeks following the IR procedures, a follow up CT abdomen revealed a giant pancreatic pseudocyst measuring 28x10x14cm. The ill-defined, partially encapsulated collection extended from the head of the pancreas and tracked retroperitoneally and inferiorly into the pelvis. It caused compression of the right ureter leading to moderate hydroureteronephrosis. Due to the immature wall formation of the pseudocyst and concerns for an acute inflammatory reaction, the patient was managed conservatively with close observation, antibiotics and serial imaging.
Discussion: Pancreatic pseudocysts can present with symptoms including abdominal pain/swelling, nausea, and emesis. Giant pancreatic pseudocysts are rare among forms of accumulated pancreatic secretions and are often the result of the inflammatory process that ensues. Of the minimal cases reported, giant pseudocysts have the capability of causing secondary organ dysfunction as they can spread, mainly downwards towards the groin via retroperitoneal hiatuses. Diagnostic imaging for diagnosis includes ultrasound, CT and MRI scans. Location and symptoms guide management; either observation (for smaller < 6cm) or invasive intervention (for larger >10cm). Surgical drainage is seen as the gold standard in the management of giant pseudocysts; it is efficient, reliable and provides symptomatic relief.
Figure: Figure 1: Radiological imaging consistent with a giant pancreatic pseudocyst extending from the head of the pancreas, tracking retroperitoneally and inferiorly into the pelvis, measuring 28x10x14cm (Coronal View).
annabelle Alvarez indicated no relevant financial relationships.
Natalie Donn indicated no relevant financial relationships.
Melissa Matheus indicated no relevant financial relationships.
Emmanuel McDonald indicated no relevant financial relationships.
Jose Paz indicated no relevant financial relationships.
annabelle Alvarez, DO1, Natalie Donn, DO1, Melissa Matheus, MD1, Emmanuel A. McDonald, DO2, Jose Paz, DO1. P0103 - It’s HUGE!...The Case of a Rare, Giant Pancreatic Pseudocyst, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.