Spontaneous drainage of the pseudocyst of the tail of the pancreas with the formation of a junction between the cyst and the stomach

The aim of the study was to evaluate the informative value of various diagnostic methods for spontaneous drainage of the pancreatic pseudocyst into the stomach.

Materials and methods: based on the clinical observation of a patient who received complaints of pain in the epigastrium, an episode of melena, after suffering acute pancreatitis several years ago with the development of pancreatic necrosis with an outcome in the cyst of the tail of the pancreas, drainage of the omentum bag. The patient underwent a comprehensive laboratory and instrumental examination.

Results: ultrasound, endoscopic examination, MSCT suspected a malignant process in the stomach with ulceration and germination into the pancreas. After performing endoscopic ultrasonography, it was possible to differentiate the layers of the formation and make the correct diagnosis, which was confirmed by subsequent MSCT with oral contrast.

Conclusions: a spontaneously opened pancreatic pseudocyst in the lumen of the stomach is a rare and difficult to diagnose disease. An integrated approach, including endoscopic, ultrasound, X-ray, and laboratory methods of investigation when compared with the clinical picture, allows us to verify the formation of the pancreas.

1. Sitnikov V.A., Varganov M. V., Styazhkina S. N., et al, Acute pancreatitis: a textbook for doctors and students. Izhevsk. 2008, 120 P. (In Russ.)

2. Zatevakhin I.I., Kiriyenko A. I., Kubyshkin V. A. Abdominal surgery: National guidelines: a short edition. GEOTAR-Media. 2016, 912 P. (In Russ.)

3. Bazaev A.V., Malov A. A., Zaharov A. G., Postnecrotic cyst of the pancreas, complicated by internal gastric fistula (clinical case). Vestnik novih medical technologies. 2016, vol. 23 (1), pp. 49–52. (In Russ.)

4. Degtyareva Yu.S., Zyablova E.l., Agurina N. V., Shevchenko E. G. Clinical case of multiple pancreatic pseudocysts prevalent in the posterior mediastinum. Innovative medicine of Kuban. 2016, no. 1, pp.50–54. (In Russ.)

5. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993 May;128(5):586–90. doi: 10.1001/archsurg.1993.01420170122019.

6. Soliani P., Franzini C., et al., Pancreatic Pseudocysts Following Acute Pancreatitis: Risk Factors Influencing Therapeutic Outcomes. JOP, 2004, vol. 5(5), pp. 338–47. PMID: 15365200.

7. Edward L. Bradlvey, Clements J. L., et al. The natural history of pancreatic pseudocysts: a unified concept of management. AJS. 1979;137 (1):135–141. doi:10.1016/0002-9610(79)90024–2

8. Shatney C.H., Lillehei R. C. The timing of surgical treatment of pancreatic pseudocysts. Surg Gynecol Obstet. 1981;152(6):809–12. PMID: 7244958.

9. Vitas G.J., Sarr M. G. Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery. 1992;111(2):123–30. PMID: 1736380.

10. Varadarajulu S., Bang J. Y., Sutton B. S., Trevino J. M., Christein J. D., Wilcox C. M. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145(3):583–90. doi: 10.1053/j.gastro.2013.05.046. PMID: 23732774.