Beating the Odds
A Rare Case of Intrahepatic Pseudocyst of Pancreas
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
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.
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 patient recovered uneventfully. He is doing well now and leading
a normal life.
Purely Intrahepatic Pseudocyst of pancreas is a rare finding. Not many
cases have been reported in the literature.