Abstract
A 67–year–old man admitted in an emergency for severe left backache and left hypochondrium in April 2010 was shown in laboratory data to have elevated serum amylase concentration of 443 IU/L and inflammatory reaction, yielding a diagnosis of acute pancreatitis. Abdominal computed tomography (CT) showed a pancreatic tail cyst 3.2 cm in diameter. Despite symptomatic relief by conservative treatment after admission, his serum amylase concentration and inflammatory reaction persisted. CT on hospital day 12 showed cyst growth and fluid collection in the left infraphrenic space and left pleural cavity. Amylase concentration in left infraphrenic ascites was 55,966 IU/L. Based on a preoperative diagnosis of ruptured pancreatic pseudocyst and gradual cyst growth, we conducted distal pancreatectomy with splenectomy on hospital day 31. Gross examination of the resected specimen showed a coagulum–filled cyst 3.8 cm in maximum diameter. Microscopically, the cyst wall consisted of fibrous connective tissue, with macrophages in cluding hemosiderin scattered within the wall, suggesting cyst rupture by intracystic bleeding. The man′s postoperative course was uneventful and he was discharged on postoperative day 17. Rupture potential should be considered if conservative treatment increases serum amylase concentration and inflammation persists.
