Multiple Pancreatic Pseudocysts Treated with Endoscopic Transpapillary Drainage
Our patient is a 44-year old African American lady who presented to the emergency room with acutely worsened abdominal pain on a background of several week history of chronic abdominal pain associated with nausea and vomiting. Patient had a history of alcohol abuse. She had a laparoscopic cholecystectomy done 10 years prior for acute calculous cholecystitis. A computed tomography (CT) scan was performed which showed multiple pseudocysts in relation to the body and tail of pancreas (). Pancreatic enzymes, amylase and lipase, were borderline abnormal. She was diagnosed with alcohol induced pancreatitis complicated with pseudocysts. In view of symptomatic mature pseudocysts, a drainage procedure was mandated. Endoscopic retrograde pancreatogram was performed which showed a markedly dilated pancreatic duct and filling of a saccular structure inferior to the pancreatic tail, consistent with a visible communication with the cyst(s) (). We attempted transpapillary drainage of the cystic spaces through placement of a 5 French×7 cm (Cook Medical, Limerick, Ireland) pancreatic duct stent. Patient did well post-procedure and was discharged home after 72 h with good pain control.\nTwo weeks later the patient was readmitted with high fevers and worsening abdominal pain. A repeat endoscopic pancreatogram showed a dilated pancreatic duct in the body of pancreas with tapering in the region of head, suggesting occlusion of the stent. This was treated by balloon dilatation and replacement with a single pigtail stent, 5 French×10 cm (Cook Medical) in the pancreatic duct. Postprocedure, the patient recovered well with 7 day antibiotic treatment. A follow up CT scan after 3 and 6 months showed significant resolution in the pseudocysts ( and ) with remarkable improvement in symptoms of abdominal pain. Patient was referred to the deaddiction clinic to prevent further attacks of alcoholic pancreatitis.