Atypical extensive pancreatic pseudocyst with hemorrhage in a hemodialysis patient

Spontaneous Hemorrhage into the Pseudocyst of the Pancreas Without Pseudoaneurysm: A Report of Rare Case and Literature Review

The pseudocysts of the pancreas usually occur in cases of acute or chronic pancreatitis due to damage to the pancreatic ducts. Alcohol abuse is the most common cause of acute or chronic pancreatitis. Hemorrhage into the pseudocyst is one of the most lethal complications of pancreatic pseudocyst. In this article, we present the case of a 49-year-old male patient who presented to the emergency room with primary symptoms of pain in the upper abdomen and vomiting that had been occurring for two days and had worsened over the past eight hours. He is a follow-up case of chronic pancreatitis, as well as stable pseudocysts located in the lesser sac, peripancreatic, and epigastric regions. Additionally, the patient had a history of alcohol misuse. The contrast-enhanced computed tomography (CECT) examination of the abdomen and pelvis revealed an enlarged pancreas, hypodense and heterogeneously enhancing pancreatic parenchyma, diffuse peripancreatic fat stranding, and fluid collections. There are a few well-defined hypodense, peripherally enhancing lesions in the lesser sac, peripancreatic, and epigastric regions. On a plain computed tomography (CT) scan, the lesion in the lesser sac showed hyperdense (65 HU) and heterogeneous areas, indicating intracystic hemorrhage. On CT angiography and digital subtraction angiography (DSA), there was no detectable source of bleeding into the pseudocyst. The patient was diagnosed with acute-on-chronic pancreatitis with pseudocysts and spontaneous hemorrhage in the pseudocyst without the presence of a pseudoaneurysm. Conservative treatment was recommended as the patient was hemodynamically stable, and no pseudoaneurysms were detected on the CECT or DSA. The patient exhibited a positive response to the treatment and was discharged in stable condition. The patient was recommended to have a conclusive procedure at a later date. A cystogastrostomy was performed after a period of one month. The postoperative recovery was unremarkable. The purpose of this case report is to highlight the significance of using computed tomography (CT) and angiography for promptly identifying the rare occurrence of hemorrhage into the pseudocyst of the pancreas. Additionally, it emphasized the uncommon occurrence of hemorrhage in the pseudocysts, along with their typical presentation and radiological evaluation.

A pancreatic pseudocyst sitting in the mediastinum-A case report of an unusual occurrence

Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen but can rarely extend into the mediastinum. Atypical symptoms such as dyspnea, dysphagia, coughing, vomiting, abdominal or chest pain, and hemoptysis are usually the notable complaints. CT scan, MRI, and endoscopic ultrasound are valuable diagnostic modalities. Drainage and surgical removal of the pseudocyst are the treatment options. Herein, we outline the case of a young female with episodic chest and epigastric discomfort, dysphagia, and weight loss. Previously, she was incorrectly diagnosed with gastroesophageal reflux disease and peptic ulcer. A mediastinal pseudocyst secondary to chronic pancreatitis was found to be the cause. The patient underwent surgical removal of the pseudocyst and a pancreaticojejunostomy. Significant improvement was noticed at follow-up. This article highlights the possibility of such unusual conditions and the importance of a proper assessment while treating patients with epigastric pain.

Endoscopic Combined Drainage of One Giant and Multiple Small Pancreatic Pseudocysts: A Case Report

A pancreatic pseudocyst (PPC) is a frequent complication of pancreatitis, often stemming from alcohol, gallstones, or hyperlipidemia. Endoscopic treatment of PPC has become the mainstream treatment. A case of one giant and multiple small PPCs was observed, manifesting as repeated abdominal bloating, abdominal pain, nausea, and vomiting after meals. Initial computed tomography scans revealed the presence of multiple PPCs. Despite ineffective medical treatment, the pseudocysts progressively increased. In response, we conducted a combined endoscopic intervention, involving Hot AXIOS (Boston Scientific, Marlborough, MA) stenting through endoscopic ultrasound-guided transmural drainage (EUS-TMD) and the placement of the endoscopic nasopancreatic drainage (ENPD) mimic stent through endoscopic retrograde pancreatography (ERP). Remarkably, after nine months of postoperative follow-up, the patient had no discomfort symptoms and the cyst disappeared. We conducted a literature review on endoscopic combined drainage for PPCs, which is still controversial. Our presented case serves as a demonstration that endoscopic combined drainage can effectively and successfully manage giant and multiple PPCs.

Successful treatment of mediastinal pancreatic pseudocyst and pancreatic pleural effusion with endoscopic pancreatic duct drainage: A case report

An 81‐year‐old man with chronic pancreatitis was being treated with a protease inhibitor. He developed an acute exacerbation of chronic pancreatitis and dyspnea. Contrast‐enhanced computed tomography showed disruption of the main pancreatic duct, a cystic lesion connecting the mediastinum to the main pancreatic duct, and left pleural effusion. We diagnosed a pancreatic pseudocyst, mediastinal pancreatic pseudocyst, and pancreatic pleural effusion. Endoscopic retrograde pancreatography showed leakage of contrast medium from the pancreatic body; furthermore, a cystic cavity extending to the mediastinum through a pancreatic duct fistula was visualized. An endoscopic transpapillary nasopancreatic drainage tube was placed in the cystic cavity. Computed tomography showed that the mediastinal pseudocyst and pleural effusion had disappeared. Endoscopic transpapillary pancreatic duct drainage may be useful when a connection between the main pancreatic duct and a mediastinal pseudocyst is confirmed by imaging.