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Case Reports
. 2021 Jun 29;13(6):e16039.
doi: 10.7759/cureus.16039. eCollection 2021 Jun.

Recurrent Pancreatic Pseudocysts Due to Alcohol-Related Chronic Pancreatitis With Double-Duct Sign and Spontaneous Rupture

Tanveer Hasan  1 , Pranav Jha  1 , Sunil Thippeswamy  2
Affiliations
Case Reports

Recurrent Pancreatic Pseudocysts Due to Alcohol-Related Chronic Pancreatitis With Double-Duct Sign and Spontaneous Rupture

Tanveer Hasan et al. Cureus. .

Abstract

A 36-year-old female presented with recurrent attacks of alcohol-related acute on chronic pancreatitis complicated by a pancreatic pseudocyst in the head of the pancreas. The cyst was causing obstruction of the common bile duct (CBD) and pancreatic duct (PD) on magnetic resonance cholangiopancreatography (MRCP). She underwent endoscopic ultrasound (EUS)-guided aspiration of the cyst to dryness. A few months later, she presented with epigastric pain and jaundice. MRI pancreas and MRCP revealed a pancreatic cyst in the head of the pancreas, which had grown in size, compressing the CBD and PD with extra and intrahepatic biliary dilatation. There was a recurrence of a new lobulated peripancreatic pseudocyst, which had ruptured resulting in a large collection compressing the right renal capsule. Percutaneous drainage of the ruptured pseudocyst was performed, followed by endoscopic retrograde cholangiopancreatography (ERCP) that revealed distal CBD stricture, which was stented. Her symptoms improved and she was discharged with no further recurrences of obstructive jaundice during the one-year follow-up period.

Keywords: chronic pancreatitis; double duct sign; endoscopy ercp; magnetic resonance cholangiopancreatography (mrcp); pancreatic pseudocysts; spontaneous rupture.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI of the pancreas and abdomen on the first visit
The image shows a 8 x 3 x 3-cm pseudocyst in the head of the pancreas (red arrow) MRI: magnetic resonance imaging
Figure 2
Figure 2. MRCP showing pseudocyst in the head of the pancreas (red arrow)
The pseudocyst can be seen exerting mass effect over adjacent structures, causing dilatation of the pancreatic duct (blue arrow) and common bile duct (yellow arrow) - the double-duct sign, with early intrahepatic biliary tree dilatation MRCP: magnetic resonance cholangiopancreatography
Figure 3
Figure 3. MRCP showing pancreatic pseudocyst in the head of the pancreas (red arrow)
The pseudocyst is seen measuring 4.8 x 4.6 cm causing local pressure effect with marked intra and extrahepatic biliary dilatation (yellow arrows) MRCP: magnetic resonance cholangiopancreatography
Figure 4
Figure 4. MRI of the pancreas and abdomen
The images show evidence of chronic pancreatitis and two pancreatic pseudocysts, one of which is in the head of the pancreas (blue arrows) measuring 4.8 x 4.6 cm causing a local pressure effect on the CBD (yellow arrow). The other large peripancreatic pseudocyst (red arrows) measuring about 7 x 4 cm has ruptured causing collection sized 12.9 x 11.2 x 13.0 cm, compressing on the right renal capsule MRI: magnetic resonance imaging; CBD: common bile duct
Figure 5
Figure 5. CT abdomen showing multiple pseudocysts (blue arrow), which have significantly reduced in size. A metallic biliary stent is seen, which is patent (red arrow)
CT: computed tomography
See this image and copyright information in PMC

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