A CASE OF SUCCESSFUL MANAGEMENT OF A MEDIASTINAL PANCREATIC PSEUDOCYST WITH ENDOSCOPIC TRANSPAPILLARY DRAINAGE WITHOUT RECURRENCE AFTER THE REMOVAL OF A STENT

Abstract

A 75-year-old man with a past history of chronic pancreatitis presented with dyspnea and general fatigue. CT images showed massive left pleural effusion and a large pancreatic pseudocyst extending to the mediastinum. Pleural fluid with a high amylase level rapidly disappeared with thoracic cavity drainage. As conservative medical treatment was ineffective for six months, we performed ERCP and inserted a 5 Fr plastic stent into the pseudocyst across the fistula through the pancreatic duct. Four months later, MRCP demonstrated complete disappearance of the pseudocyst. Another two months later, the stent was able to be removed. The patient has remained in good condition without recurrence for eight months after the removal of the stent. Our case suggests that endoscopic transpapillary drainage is a useful treatment method for the mediastinal pancreatic pseudocyst.