A Case of Mediastinal Pancreatic Pseudocyst Treated by Planned Internal Drainage

Abstract

Pancreatic pseudocyst is a known complication of chronic pancreatitis. It is generally found in the abdominal cavity and rarely extends to the mediastinum. A 67-year-old man with a history of alcoholism visited a clinic because of epigastralgia. He was diagnosed as having acute chronic pancreatitis and was admitted to hospital. A computed tomography examination revealed an internal pancreatic fistula extending through the esophageal hiatus from the pancreatic pseudocyst in the pancreatic body to cystic lesions in the mediastinum. Endoscopic treatment was deemed to be difficult, and we treated the patient conservatively. However, the conservative treatment was ineffective, and we subsequently performed a planned transgastric internal fistulization of the pancreatic pseudocyst. His postoperative course was uneventful, and he was discharged from hospital. The technique used in the present case might be a useful and important treatment method for pancreatic pseudocyst in cases where endoscopic treatment is thought to be difficult.