A 57-year-old man with a history of alcoholic chronic pancreatitis and diabetes presented to another hospital with hypoglycemia. Our department was consulted because computed tomography revealed left pleural effusion and a cystic lesion in the mediastinum adjacent to the body of the pancreas. Endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the main pancreatic duct and leakage of the contrast material from the pancreatic body. Therefore, we inserted a 5-Fr endoscopic nasopancreatic drainage tube into the fistula through the pancreatic duct. Then, we placed a pancreatic duct stent to bridge the disruption after achieving reduction of the mediastinal pseudocyst. On day 17 of hospitalization, we replaced the 7-Fr stent with a 10-Fr stent because of persisting stenosis and disruption. After ERCP showed improvement, the stent was removed and the patient was discharged on day 45. In this case, endoscopic transpapillary drainage was useful for treating the mediastinal pancreatic pseudocyst.
