Beating the Odds

A Rare Case of Intrahepatic Pseudocyst of Pancreas

THE CASE

A 55-year old male patient was admitted to Nanavati Super Speciality Hospital with complaints of severe pain in the abdomen and a visible lump in the upper abdomen for the past 7 days. The patient was diagnosed with Pseudocyst of pancreas a few months back and had undergone Percutaneous aspiration of Pseudocyst at some other hospital 10 days before the admission, following which the symptoms appeared. The patient is a teetotaler and has a history of recurrent Pancreatitis.

Investigation findings revealed the WBC counts to be at 22400/cu 50mm and Sr. Amylase at 3200 IU/ Lit, while Sr. Lipase was found to be 2000 IU / Lit. His CT scan result showed multiple loculated pockets of collection in the intrapancreatic region, with the largest one in the anterior pararenal space of 12cm × 6cm × 3cm with significant fat stranding. Another collection measuring 11cm × 3cm was observed tracking along the descending colon into the pelvis. Similar capsulated fluid collection of 44cm × 32cm abutting the tail of pancreas up to greater curvature of stomach MRCP confirmed the findings. Diagnosis of Pseudocyst of the pancreas with infection / haemorrhage was also identified.

THE PROCEDURE

Initially, exploratory Laparotomy was performed. A large cyst with straw coloured fluid approximately 2.5 litres was located inside the liver parenchyma with a thinned out liver capsule. On exposing the pancreas by opening the lesser sac, no other cysts were found. The cyst was excised completely from the liver parenchyma, and the liver capsule was sutured back.

On histopathological examination of the cyst wall, diagnosis of Pseudocyst was confirmed. Amylase level of cyst fluid was found to be 18000 IU. Thus the diagnosis of pancreatic Pseudocyst which was intrahepatic was confirmed.

THE RESULT

The patient recovered uneventfully. He is doing well now and leading a normal life.

DISCUSSION

Purely Intrahepatic Pseudocyst of pancreas is a rare finding. Not many cases have been reported in the literature.

Dr. Amol Joshi
Consultant
Laparoscopic & General
Surgeon
Nanavati Super Speciality
Hospital, Mumbai