抄録
A 49-year-old man was admitted to our hospital because of an elevated lesion in the stomach. The gastric submucosal tumor located at posterior wall of the upper body and the size of the tumor was 30 mm in diameter.
Endoscopic ultrasonography (EUS) showed a cystic lesion in the submucosal layer of the stomach and its connection with pancreatic body through the fistula. Abdominal CT scan and MRCP showed a cystic lesion at the stomach and cysts in the pancreatic body and tail. Endoscopic retrograde pancreatography showed stenosis and stopping of the main pancreatic duct (MPD) at the pancreatic body, but pancreatic cysts and cystic lesion of the stomach could not be observed. EUS-guided needle aspiration and cystography were performed for the evaluation of cystic lesion of the stomach. Cystography showed cystic lesion of the stomach and its connection with MPD through the fistula. Levels of amylase and lipase were very high in the fluid of cystic lesion of the stomach.
This patient was diagnosed as having a chronic pancreatitis with a pancreatic pseudocyst and its penetration into the stomach wall. Distal pancreatectomy accompanied with splenectomy and partial gastrectomy were performed. Histological study confirmed the clinical diagnosis. Pancreatic pseudocyst is a common complication of chronic pancreatitis but its penetration into the stomach is rare. EUS-guided needle aspiration and cystography using the color Doppler method were safe and useful for diagnosis of pancreatic cystic lesions.
