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Case Reports
. 2018 Apr 23;18(1):52.
doi: 10.1186/s12876-018-0781-3.

Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation

Martino Gerosa  1 , Marco Chiarelli  1 , Angelo Guttadauro  2 , Matilde De Simone  3 , Fulvio Tagliabue  1 , Melchiorre Costa  1 , Sabina Terragni  2 , Ugo Cioffi  4
Affiliations
Case Reports

Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation

Martino Gerosa et al. BMC Gastroenterol. .

Abstract

Background: Pancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak.

Case presentation: We describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution.

Conclusion: Pancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.

Keywords: Acute pancreatitis; Jaundice; Pancreatic cystic mass; Pancreatic duct rupture; Pseudocyst.

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Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available on request.

Competing interests

None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

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Figures

Fig. 1
Fig. 1
a-b CT scans showed multiple defined hypodense lesions with peripheral contrast enhancing pancreatic areas compatible with cystic lesions. The main one involved the head of the pancreas and measured 12 cm in diameter
Fig. 2
Fig. 2
MRCP scan confirmed multiple confluent pancreatic cysts. It revealed a communication between the main pancreatic duct and the cystic mass suspected for Wirsung duct rupture in the pancreatic tail
Fig. 3
Fig. 3
EUS showed pancreatic head cystic lesion with thickened walls and serous content
Fig. 4
Fig. 4
Surgical view. After anterior and posterior gastric walls were opened pancreatic pseudocyst appeared and its cavity entered for drainage
See this image and copyright information in PMC

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References

    1. Poornachandra KS, Bhasin DK, Nagi B, Sinha SK, Rana SS, Shafig N, et al. Clinical, biochemical, and radiologic parameters at admission predicting formation of a pseudocyst in acute pancreatitis. J Clin Gastroenterol. 2011;45:159–163. doi: 10.1097/MCG.0b013e3181dd9d14. - DOI - PubMed
    1. Varadarajulu S, Rana S, Bhasin D. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am. 2013;23:863–892. doi: 10.1016/j.giec.2013.06.008. - DOI - PubMed
    1. Gumaste VV, Pitchumoni CS. Pancreatic pseudocyst. Gastroenterologist. 1996;4:33–43. - PubMed
    1. Warshaw AL, Facts RDW. Fallacies of common bile duct obstruction by pancreatic pseudocysts. Am J Surg. 1980;192:33–37. - PMC - PubMed
    1. Larsen M, Kozarek R. Management of pancreatic ductal leaks and fistulae. J Gastroenterol Hepatol. 2014;29:1360–1370. doi: 10.1111/jgh.12574. - DOI - PubMed

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