Atypical extensive pancreatic pseudocyst with hemorrhage in a hemodialysis patient

Abstract

Pancreatic pseudocysts are a common complication of both acute and chronic pancreatitis. The complications of pancreatic pseudocysts include compression of abdominal great vessels, gastric or duodenal stenosis, cholestasis due to stenosis of common bile duct, infection, and hemorrhage into the cyst. Moreover, pancreatic pseudocysts most commonly occur around the pancreas; however, extension into the adjacent viscera including spleen, liver, transverse colon, anterior or posterior pararenal space, retroperitoneum and mediastinum does occur infrequently. Here, we report a rare case of atypical extensive pancreatic pseudocyst with hemorrhage in a hemodialysis patient.

Keywords: Atypical Extension; Chronic Pancreatitis; Hemodialysis; Hemorrhage; Intra-cystic Bleeding; Pancreatic Pseudocyst.

Fig. 1

Axial view of abdominal CT on initial presentation showed hyperdense central area within mass in the dorsum of the right kidney and retroperitoneum.

Fig. 2

A: Axial view of abdominal CT with contrast on admission showed chronic pancreatitis and a right retroperitoneal cystic lesion with intra-hypodense fluid in the dorsum of the right kidney and retroperitoneum. B: Coronal view. C: Sagittal view.

Fig. 3

Upper endoscopy showed only blood clots on the descending and third portion of duodenum.

Fig. 4

A: The right retroperitoneal cystic lesion was drained to control intra-cystic bleeding and the size decreased. Arrow showed drainage tube. B and C. One-year follow-up, pancreatic pseudocyst continued to get smaller and the extension into the dorsum of the right kidney and retroperitoneum was resolved. (B: pancreas and spleen level; C: bilateral kidney level).

Fig. 5

Total 300 ml fluid was drained, and drained fluid was bloody. About 4 ml bloody fluid was in the tube.