Idiopathic giant pancreatic pseudocyst presenting in emergency with abdominal compartment syndrome and
intestinal occlusion: Case report and review of the literature.
Int J Surg Case Rep 2021;
81:105812. [PMID:
33887838 PMCID:
PMC8049989 DOI:
10.1016/j.ijscr.2021.105812]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/08/2022] Open
Abstract
Idiopathic giant pancreatic pseudocyst (IGPP) is a rare pancreatic disease.
Diagnosis of IGPP in emergency [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]] is a challenge because of its rarity, the absence of history of pancreatitis and specific symptoms and signs.
IGPP may cause intestinal obstruction, intra-abdominal hypertension and abdominal compartment syndrome requiring a decompressive laparotomy.
Distal pancreaticosplenectomy may be the correct treatment of undiagnosed IGPP if there is suspicion or inability to exclude a malignant cystic pancreatic neoplasm.
Introduction and importance
This is the first case of idiopathic giant pancreatic pseudocyst (IGPP) causing intestinal occlusion, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) reported in the literature. Diagnosis of IGPP in emergency is a challenge because of its rarity and the absence of a history of pancreatitis or pancreatic trauma and specific clinical presentation. Abdominal contrast-enhanced computed tomography (CECT) represents the gold standard in diagnosing of pancreatic cyst (PP). Different types of treatment of PP are reported in the literature.
Case presentation
A 52-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain, inability to pass gas or stool, nausea and vomiting, oliguria and a seven-day history of abdominal swelling and swollen legs. Physical examination revealed abdominal distention, abdominal pain, swelling in the legs. CECT showed a voluminous cystic pancreatic mass suspected of neoplasm. Laboratory tests reported high serum levels of BUN, creatinine and C-reactive protein and neutrophilic leukocytosis. After preoperative diagnosis of ACS, the patient was taken to the operating room for pancreatic resection. The postoperative course was uneventful. Diagnosis of IGPP was made by histopathological examination.
Clinical discussion
IGPP is difficult to diagnose in emergency. Although different types of drainage of IGPP are described in the literature, pancreatic resection represents the treatment of choice when a cystic pancreatic neoplasm cannot be excluded.
Conclusion
IGPP is a rare disease that may cause intestinal occlusion, IAH and ACS. Pancreatic resection if necessary is safe and therapeutic with acceptable morbidity and mortality.
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