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Case Reports
. 2008 Sep;2(3):390-7.
doi: 10.1159/000163377. Epub 2008 Nov 11.

Pseudocyst in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage

Itaru Naitoh  1 , Hirotaka Ohara, Yasutaka Okayama, Takahiro Nakazawa, Tomoaki Ando, Kazuki Hayashi, Fumihiro Okumura, Yasuhiro Kitajima, Tessin Ban, Katsuyuki Miyabe, Koichiro Ueno, Takashi Joh, Hitoshi Sano
Affiliations
Case Reports

Pseudocyst in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage

Itaru Naitoh et al. Case Rep Gastroenterol. 2008 Sep.

Abstract

We report a 50-year-old male with pseudocysts in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage. He had previously undergone ultrasonography-guided percutaneous cyst drainage for a pancreatic pseudocyst in our hospital. He was readmitted due to abdominal pain and fever. Computed tomography showed recurrence of a pseudocyst in the pancreatic tail measuring 5 cm in diameter. Since conservative treatment failed, endoscopic retrograde pancreatography was performed. There was communication between the pseudocyst and the main pancreatic duct, and pancreatic duct stenosis proximal to the pseudocyst. First, transpapillary pancreatic duct drainage was performed using a plastic stent, but the pseudocyst did not decrease in size and became infected. After removal of the stent, a pigtail type nasocystic catheter was placed in the pseudocyst via the pancreatic duct. The pseudocyst infection immediately disappeared, and the pseudocyst gradually decreased and disappeared. After removal of the nasocystic catheter, no recurrence was observed. As transpapillary drainage of pancreatic pseudocyst, cyst drainage and pancreatic duct drainage have been reported. In our patient with pseudocyst in the pancreatic tail, duct drainage was ineffective and the pseudocyst was infected, whereas cyst drainage was very effective. We considered that cyst drainage by a nasocystic catheter was the first-line therapy as the transpapillary drainage of the pancreatic pseudocyst.

Keywords: Nasocystic catheter; Pancreatic cyst drainage; Pancreatic duct drainage; Pancreatic pseudocyst; Pancreatic stent; Transpapillary drainage.

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Figures

Fig. 1
Fig. 1
CT showed a large pseudocyst measuring 5 cm in diameter and some small cysts in the pancreatic tail.
Fig. 2
Fig. 2
Endoscopic retrograde pancreatography showed communication between the pseudocyst (arrows) and the main pancreatic duct, and a main pancreatic duct stenosis (arrowhead) proximal to the pseudocyst.
Fig. 3
Fig. 3
A pigtail type nasocystic catheter was placed in the pseudocyst via the pancreatic duct.
See this image and copyright information in PMC

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