Intra-thoracic pancreatic pseudocyst: a rare complication of traumatic pancreatitis

Abstract

The commonest complication of traumatic pancreatitis is the development of pancreatic pseudocyst. We report a patient with traumatic pancreatitis following blunt abdominal trauma who developed an intrathoracic pancreatic pseudocyst late in the course of non-operative management, and discuss the management of this very rare complication of traumatic pancreatitis.

Childhood Pancreatitis

“…These signs of haemorrhagic pancreatitis are seldom present in children (Nydegger et al, 2006). Evidence of pleural effusion or dyspnoea, with or without acute respiratory distress syndrome, may be found on examination of the chest (Uretsky et al, 1999, Ali et al, 2010. Recurrent acute pancreatitis is seen in 10% of children after the initial acute episode.…”

“…A significantly elevated level of pleural fluid amylase/lipase with concentrations higher than those obtained from patient's serum sample, may be encountered following traumatic pancreatitis. Intrathoracic pancreatic pseudocyst has been reported following traumatic pancreatitis where, eventually, persistent pancreatic ductal leak was successfully managed with ERCP stenting of the pancreatic duct (Ali et al, 2010).…”

“…Thoracic pancreatic pseudocyst as a complication of traumatic pancreatitis has been reported (Ali et al, 2010).…”

“…It is particularly helpful for its diagnostic and therapeutic roles in the management of children with acute obstructive biliary pancreatitis. ERCP and pancreatic duct stenting can also be beneficial in trauma patients in whom a ductal injury is suspected or a pancreatic pseudocyst has formed (Mehta & Gittes, 2005, Ali et al, 2010. In cases of pancreas divisum, however, cannulation of the minor papilla is possible in less than half of the cases because of its small size and the angle at which it meets the duodenum (Miyano, 2006).…”

“…Initial nonoperative management of injuries of the proximal pancreatic duct is a common practice and allows for the formation and uneventful delayed drainage of a pseudocyst, rather than the risks of early radical interventions (Jobst et al, 1999). If there is delayed or no response to conservative management, ERCP with sphincterotomy and/or stenting of injured pancreatic duct may be attempted as it has reportedly had a proven efficacy in resolving the symptoms in such patients (Cay et al, 2005;Canty & Weinman, 2001;Ali, 2010). Distal duct injuries are best managed by prompt spleen-sparing distal pancreatectomy (Jobst et al, 1999).…”