Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature
A 21-year-old gentleman was referred to us with the history of intermittent left flank pain of 2 weeks duration. He had no previous history of biliary lithiasis, alcohol consumption or abdominal surgeries. Computed tomography (CT) Kidneys, Ureter, Bladder showed a left renal pelvic calculus of 10 mm × 8 mm without any hydronephrosis []. No other abnormality was detected on the CT scan. His blood chemistry and urine analysis were normal. SWL (Dornier Compact Delta, Germany) was performed at 15 kv with 60 shocks per minute for a total of 2700 shock waves, using fluoroscopic guidance.\nApproximately 24 h after SWL, he developed severe pain in the epigastrium and peri-umbilical regions with persistent vomiting. On physical examination, he had tachycardia and was tachypnoeic. Blood pressure was 130/80 mmHg. His abdomen was distended and mild guarding in the epigastrium and periumbilical region was present. On biochemical evaluation, he had an increase in white blood cells count (17 × 103 μ/L), renal and liver function tests were within normal limits. X-ray abdomen and X-ray chest were normal. Ultrasound showed minimal peri-pancreatic fluid collection. Rest of the abdomen was normal. Serum amylase was 1165 μ/L (normal range: 30-110 μ/L) and serum lipase was 8625 μ/L (normal range 15-322). CT scan of abdomen done 48 h after the onset of pain showed features of acute pancreatitis with inflammatory exudate in the peri-pancreatic space, sub-hepatic space and pelvis and minimal left pleural effusion [Figures and ]. There was no evidence of pancreatic necrosis in the contrast enhanced CT scan. Blood and urine culture reports revealed no growth.\nHe was treated conservatively with nasogastric tube insertion, bowel rest, parenteral nutrition, intravenous antibiotics and intravenous somatostatin. His pancreatic enzymes returned to normal within 5 days and follow-up CT scan performed 2 months after the acute episode showed the resolution of features of acute pancreatitis with the formation of pseudo cyst in the body and fail of pancreas measuring 12 cm × 8 cm × 8 cm []. No residual fragment of renal calculus was found in the follow up CT scan. Later he underwent surgery for persistent pseudocyst of pancreas.