A CASE OF PANCREATIC PSEUDOCYST TREATED WITH ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE INSERTED PERCUTANEOUSLY INTO THE AFFERENT JEJUNAL LOOP

Abstract

This case involves a 56-year-old male patient. He had undergone a pylorus-preserving pancreaticoduodenectomy for the treatment of bile duct cancer. While he was being followed up for a pancreatic pseudocyst that had developed after the surgery, he attended the emergency room with fever and abdominal pain. A blockage of the afferent jejunal loop, which was caused by an increase in the size of the pancreatic pseudocyst, was found on CT scan imaging. As the afferent jejunal loop had penetrated into the abdominal skin, it was treated with echo-guided percutaneous drainage. Endoscopic ultrasound-guided drainage using an echo-guided percutaneous drainage route was considered for the treatment of the pancreatic pseudocyst. First, the external skin of the fistula was dilated enough for the insertion of the ultrasonic endoscope itself. Thereafter, the ultrasonic endoscope was inserted percutaneously into the afferent jejunal loop in preparation for puncturing the pancreatic pseudocyst. At a later date, it became possible to insert the endoscope into the pancreatic pseudocyst through the jejunum, and later debridement was also performed. Consequently, the pancreatic pseudocyst was successfully treated.