The effectiveness of conservative therapy for a pancreatic pseudocyst penetrating into the spleen with complicating infection : A case report

Abstract

A man in his forties was admitted to our hospital complaining of an abdominal pain. The CT and MRI demonstrated a pancreatic pseudocyst whose diameter was larger than 110mm and a pancreatic calculus in the main pancreatic duct. The patient underwent ERP which showed a pancreatic calculus and pancreatic pseudocyst that communicated with the main pancreatic duct. The patient underwent EPST (endoscopic pancreatic sphincterotomy) and ENPD (endoscopic nasopancreatic duct drainage) , however the CT images taken after 14 days showed that the pancreatic pseudocyst increased and penetrated into the spleen with complicated infection. The patient underwent the EUS-guided pancreatic pseudocyst drainage and the US-guided percutaneous perisplenic pseudocyst drainage. Then the patient underwent ESWL for the pancreatic calculus in the pancreatic head resulting, that the pancreatic calculus decreased to 10 mm from 20 mm in diameter. During the attempt of removing the pancreatic calculus by ERP, the stone had attached to the drainage tube and was removed with it. No remaining stone was evident in the following ERP. An MRI taken 2 months after discharge showed that the pancreatic pseudocyst and the penetration into the spleen had disappeared. No recurrence has been observed since then.
This case suggest that combined treatment with EUS guided drainage, endoscopic pancreatic duct drainage and US guided drainage is useful and safe for the pancreatic pseudocyst treatment that had penetrated into the spleen with infection.