2017 Volume 31 Issue 4 Pages 464-469
We present a rare case of acute on chronic pancreatitis with a pseudocyst extending up to the neck.
A 56-year-old man with acute on chronic pancreatitis was transferred to our hospital because of neck swelling and hoarseness, diagnosed as descending necrotizing mediastinitis. The patient had a medical history of multiple hospital admissions because of recurrent alcoholic pancreatitis. In the previous hospital, computed tomography-guided drainage of the pancreatic pseudocyst was performed. CT from the previous hospital showed no pancreatic pseudocyst in the abdomen. Initially during the data collection process, we had considered the possibility that the fluid accumulation was descending necrotizing mediastinitis. Contrast-enhanced CT revealed a low-density area in the prevertebral space extending from the mediastinum and communicating with the tail of the pancreas via the esophageal hiatus. Additionally, the swelling of the patient's neck disappeared without any intervention. From the data and clinical findings, the patient was diagnosed with a paraesophageal abscess. Abscess drainage under video-assisted thoracic surgery was carried out, and the fluid specimen showed a markedly high value of amylase (100.000 IU/L). Internal fistulization of the pancreatic pseudocyst was performed endoscopically. Thereafter, the patient recovered and was discharged. There are few reports of chronic pancreatitis with this kind of severe complication. Although a pseudocyst is a common complication of chronic pancreatitis, its extension up to the neck is extremely rare, and so we report this case.
