Endoscopic ultrasonography-guided drainage for spontaneous rupture of a pancreatic pseudocyst into the peritoneal cavity in a patient with autoimmune pancreatitis

Pancreatic pseudocyst is one of the common complications of both acute and chronic pancreatitis. While most pseudocysts resolve spontaneously with conservative treatment, larger pseudocysts are more likely to cause complications, such as, spontaneous rupture into the gastrointestinal tract and are usually associated with life-threatening bleeding, which is life threatening complication. Endoscopic or surgical drainage may be necessary for uncomplicated persistent large cysts. We present a case of 32 year old Indian male, admitted to our department, who was a known case of alcoholic acute pancreatitis treated conservatively and developed massive upper GI bleeding and shock. CT angiography and upper GI endoscopy failed so he was taken to theatre several time due to bleeding, recurrent bleeding and a major bile leak. Unfortunately, he was expired. Current study highlights this serious rare life-threatening complication.

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The Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasonography

Diagnostics ◽

10.3390/diagnostics10121005 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1005

Author(s):

Atsushi Kanno ◽

Eriko Ikeda ◽

Kozue Ando ◽

Hiroki Nagai ◽

Tetsuro Miwata ◽

...

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Ultrasonography ◽

Autoimmune Pancreatitis ◽

Wall Thickening ◽

Endoscopic Retrograde ◽

Intraductal Ultrasonography ◽

Bile Duct Wall ◽

Duct Wall

Autoimmune pancreatitis (AIP) is characterized by enlargement of the pancreas and irregular narrowing of the main pancreatic duct. It is often associated with IgG4-related sclerosing cholangitis (IgG4-SC), in which the bile duct narrows. Although characteristic irregular narrowing of the pancreatic duct caused by endoscopic retrograde cholangiopancreatography is noted in AIP, it is difficult to differentiate between localized AIP and pancreatic carcinoma based on imaging of the pancreatic duct. While stenosis of the bile duct in IgG4-SC is characterized by longer-length stenosis than in cholangiocarcinoma, differentiation based on bile duct imaging alone is challenging. Endoscopic ultrasound (EUS) can characterize hypoechoic enlargement of the pancreas or bile duct wall thickening in AIP and IgG4-SC, and diagnosis using elastography and contrast-enhanced EUS are being evaluated. The utility of EUS-guided fine needle aspiration for the histological diagnosis of AIP has been reported and is expected to improve diagnostic performance for AIP. Findings in the bile duct wall from endoscopic retrograde cholangiopancreatography followed by intraductal ultrasonography are useful in differentiating IgG4-SC from cholangiocarcinoma. Diagnoses based on endoscopic ultrasonography play a central role in the diagnosis of AIP.

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Spontaneous Rupture of Pancreatic Pseudocyst: Report of Two Cases

Case Reports in Surgery ◽

10.1155/2016/7056567 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ricardo Rocha ◽

Rui Marinho ◽

António Gomes ◽

Marta Sousa ◽

Nuno Pignatelli ◽

...

Keyword(s):

Spontaneous Rupture ◽

Pancreatic Pseudocyst ◽

Technical Difficulty ◽

Pancreatic Pseudocysts ◽

Internal Drainage ◽

Common Complication ◽

Gi Tract ◽

External Drainage ◽

Severe Peritonitis

Introduction. Pancreatic pseudocysts are a common complication of acute pancreatitis. Pancreatic pseudocyst’s natural history ranges between its spontaneous regression and the settlement of serious complications if untreated, such as splenic complications, hemorrhage, infection, biliary complications, portal hypertension, and rupture. The rupture of a pancreatic pseudocyst to the peritoneal cavity is a dangerous complication leading to severe peritonitis and septic conditions. It requires emergent surgical exploration that is often of great technical difficulty and with important morbidity and mortality.Case Study. We present two cases of spontaneous rupture of pancreatic pseudocysts, managed differently according to the local and systemic conditions.Conclusion. The best surgical choice is the internal drainage of the cyst to the GI tract; however, in some conditions, the external drainage is the only choice available.

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