Laparoscopic cystogastrostomy for pancreatic pseudocyst: a case report

Abstract

A 49-year-old man with a history of acute pancreatitis was hospitalized with a diagnosis of pancreatic pseudocyst. Ultrasonography, computed tomography, and magnetic resonance imaging all demonstrated a homogeneous cyst, 9 x 4 cm in size, at the tail of the pancreas without mural nodules or septa. Because an intestinal structure was identified between the cyst and stomach preoperatively by computed tomography and endoscopic ultrasonography, laparoscopic cystogastrostomy was carried out instead of percutaneous or endoscopic cyst drainage. The cyst was exposed by dissecting the lesser omentum and found to have no adhesion to the surrounding tissues. Anastomosis was performed using an endoscopic linear stapler via small cystotomy and gastrotomy openings on the lesser curvature, which were then sutured laparoscopically. The postoperative course was uneventful. Laparoscopic surgery is recommended as a safe, reliable, and minimally invasive treatment for managing pancreatic pseudocyst.

Figure 1.

(A) Computed tomography of the abdomen demonstrates a cystic lesion in the tail of the pancreas and an intestinal structure (arrow) between the cyst (arrowheads) and the stomach (single short arrow). (B) An upper gastrointestinal series shows extramural compression along the greater curvature of the upper body of the stomach.

Figure 2.

(A) The round, smooth surface of the cyst, which was not adherent to the surrounding tissue, was exposed by dissection of the lesser sac. (B) Each blade of an endoscopic linear stapler was inserted into the small cystotomy and gastrotomy openings on the lesser curvature to create a large anastomosis.

Figure 3.

A postoperative upper gastrointestinal series shows the contrast medium in the stomach (arrow) passes quickly into the cyst (arrowheads).