A 68-year-old man was admitted because of an infected pancreatic pseudocyst after alcoholic pancreatitis. Computed tomography revealed multiple pancreatic duct stones and multilocular pancreatic pseudocysts in his pancreatic tail. We performed endoscopic ultrasonography-guided transmural drainage of the pancreatic pseudocyst adjacent to the fundus of the stomach. It was effective for the punctured cyst, but not for the distant cysts. Therefore, we additionally performed transcutaneous drainage. Although the size of the cysts decreased, the drainage tube could not be removed because of continuous drainage of pancreatic juice. Then, we performed trans-papillary drainage by using a pancreatic duct stent. After that, the amount of pancreatic juice drained from the transcutaneous tube decreased and was successfully removed. Combined drainage from various routes is effective for treating multilocular pancreatic pseudocysts, not only when the cysts do not communicate with each other but also when they communicate with an obstructed pancreatic duct.
