A case of giant pancreatic pseudocyst successfully treated with transpapillary pancreatic drainage

Abstract

A 65-year-old male had been previously diagnosed as having alcoholic chronic pancreatitis with pancreatic stones at 40 year-old. In April 2002, he was admitted to another hospital for relapse of chronic pancreatitis. He was initially treated conservatively, however he was consulted our hospital for complication with a 15-cm giant pancreatic pseudocyst. Abdominal computed tomography (CT) and ultrasonography showed formation of multiple pseudocysts, and severe dilatation of the main pancreatic duct. Endoscopic retrograde pancreatography visualized 1-cm-stenosis in length of the main pancreatic duct at the head and severe dilatation of the main pancreatic duct at the tail. We judged that the stenosis was caused by chronic pancreatitis, and performed endoscopic naso-pancreatic drainage. After treatment, abdominal CT scan showed reduction of size of pseudocysts, then we exchanged the drainage to a 10 Fr 7-cm pancreatic stent. On his discharge, pancreatic pseudocysts vanished and dilatation of the main pancreatic duct improved. Our experience suggests that endoscopic transpapillary pancreatic drainage is one of the effective treatments for pancreatic pseudocyst.