Effectiveness of Laparoscopic External Drainage of Pancreatic Pseudocyst After Traumatic Main Pancreatic Duct Disruption: A Case Report

Abstract

We successfully treated a case of pancreatic pseudocyst caused by type IIIb pancreatic injury via laparoscopic external drainage. [Case] A 14-year-old boy presented with abdominal pain after having his upper abdomen bruised by contact with another player’s knee during a soccer match. Magnetic resonance cholangiopancreatography (MRCP) showed complete rupture of the pancreatic body, and fluid collection was detected around it. The patient was diagnosed as having type IIIb pancreatic injury based on the classification of the Japanese Society of Trauma. We selected a non-operative management approach because the patient was hemodynamically stable. However, after conservative treatment, a pancreatic pseudocyst of 3 cm diameter was found; thus, endoscopic retrograde pancreatography (ERP) was performed on the 11th day of illness. The pancreatic duct was transected at the body of the pancreas, and a pancreatic duct stent was placed into the cyst, but it fell off after three days. After that, the pancreatic pseudocyst tended to grow and increased in size from the subdiaphragm to the lower pole of the kidney. Therefore, we performed laparoscopic external drainage on the 45th day of hospitalization. After the operation, the patient showed no abdominal symptoms, and no recurrence of cysts was recognized. [Conclusion] Laparoscopic drainage of pancreatic pseudocysts can enable the observation of the entire abdominal cavity while also facilitating safe and reliable drainage. Therefore, depending on the patient condition, laparoscopic external drainage of pancreatic pseudocysts may be considered as a treatment option.