Annular Pancreatic Pseudocyst Causing Gastric Outlet Obstruction and Esophageal Reflux

Abstract

Obstruction of the stomach or of the duodenum as a result of inflammatory pancreatic disease occurs in approximately 1 % of patients who develop pancreatitis. Duodenal compression is usually the cause of anatomic obstruction. We present a patient who developed anatomic gastric outlet obstruction, reflux esophagitis, and a severe motor disorder of the esophagus due to an annular pancreatic pseudocyst that totally surrounded the distal antrum. After draining the pseudocyst, the symptoms of gastric outlet obstruction and reflux esophagitis resolved, but the esophageal motor disorder persisted. Pseudocyst formation can present in unusual ways and must be considered in the differential diagnosis of gastric outlet obstruction and esophageal reflux. Persistence of the esophageal motor disorder suggests that peristalsis of the distal esophagus is a myogenic function.