Multiple intrahepatic pseudocysts in acute pancreatitis

Intrahepatic pancreatic pseudocyst (wayward cyst): A rare presentation of traumatic pancreatitis

INTRODUCTION

Cystic lesions in the liver are commonly encountered space-occupying lesions having various etiologies such as simple cysts, malignancies, hydatid cysts, and pancreatic pseudocysts.

CASE PRESENTATION

An eight-year-old girl initially presented with acute abdominal pain, fever, and a cystic lesion in the upper abdomen. Surgical intervention was performed based on an initial diagnosis of an inflammatory cyst. Later, she developed pleural effusion. Further investigations, unveiled a cystic mass arising from the head of the pancreas, and a pancreatico-pleural fistula. Retrospective analysis revealed a history of trauma that started her illness course. Conservative management involving intercostal tube drainage and octreotide infusion resulted in a favorable outcome.

DISCUSSION

Pancreatic pseudocyst is typically results from pancreatitis or trauma but in rare cases, they can have extended to unusual locations such as the liver. This case highlights the varied presentations and complex interplay of symptoms associated with intrahepatic pseudocysts. The initial oversight of trauma in the patient's history underscore the importance of thorough history-taking for an accurate diagnosis. The complexity of this case emphasize the necessity of a multidisciplinary approach in managing such atypical presentations.

CONCLUSION

Intrahepatic pseudocysts, especially those resulting from post-traumatic pancreatic pseudocyst, are uncommon and are not typically included in the differential diagnosis of liver lesions. This case highlights the significance of identifying unusual presentation and thoroughly investigating the patient's medical history to make an accurate diagnosis. A multidisciplinary approach is essential for effective patient management in these complex cases.

An Infected Intrahepatic Pancreatic Pseudocyst and Calcified Pancreas: A Rare Complication of Chronic Pancreatitis

Pancreatic pseudocyst is a common complication of pancreatitis and is usually located in the peripancreatic space, spleen, and retroperitoneum. An infected intrahepatic pseudocyst following acute on chronic pancreatitis is extremely rare. Here, we report a case of intrahepatic pancreatic pseudocyst with superimposed infection following chronic pancreatitis in a 42-year-old female who presented with severe abdominal pain, vomiting, and bloating sensation. Her labs showed elevated pancreatic enzymes (amylase and lipase), and a provisional diagnosis of acute pancreatitis was made. Imaging revealed a cystic lesion in the left lobe and a calcified pancreas. Endoscopic aspiration of the cystic lesion and pathologic examination confirmed infected intrahepatic pancreatic pseudocyst due to the high serum amylase level and positive Enterococci on culture in aspirated cystic fluid, complicated by chronic pancreatitis.

Percutaneous drainage in the treatment of intrahepatic pancreatic pseudocyst with Budd-Chiari syndrome: A case report

BACKGROUND

Intrahepatic pancreatic pseudocyst (IHPP) is an extremely rare complication of acute pancreatitis, with only a few cases previously described in the literature. To the best of our knowledge, IHPP with Budd-Chiari syndrome (BCS) has not yet been described.

CASE SUMMARY

A 35-year-old male presented with abdominal pain, vomiting and anorexia, followed by severe swelling of the lower body after 4 d. The morphological assessment (using computed tomography revealed the presence of a huge cyst of 18.28 cm × 10.34 cm under the liver capsule accompanied by a large amount of ascites. Percutaneous puncture allowed us to detect a high level of amylase in the collection, confirming the diagnosis of IHPP. The cyst was treated by percutaneous drainage, producing complete resolution of the cyst.

CONCLUSION

IHPP can be treated with percutaneous drainage, endoscopic drainage, surgery or even conservative treatment, depending on the specific condition. We recommend percutaneous drainage as the first choice of treatment when IHPP with secondary BCS.

Intrahepatic Pancreatic Pseudocyst Complicated by Pancreatitis: A Case Report

Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11x10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.

Intrahepatic pancreatic pseudocyst: A review of the world literature

AIM

To investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).

METHODS

A literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.

RESULTS

We found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).

CONCLUSION

Diagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.

Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis

The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.

Imaging assessment of acute pancreatitis: a review

Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.