Mediastinal Pancreatic Pseudocyst Caused by Obstruction of the Pancreatic Duct Was Eliminated by Bromhexine Hydrochloride

Abstract

A 49-year-old man, who had a 30-year history of drinking the equivalent of 80 g of ethanol per day, underwent a detailed medical examination for cough and dyspnea. Chest-abdominal computed tomography and endoscopic retrograde pancreatography led to the diagnosis of a mediastinal pancreatic pseudocyst resulting from obstruction of the pancreatic duct by a protein plug. The pseudocyst rapidly improved with conservative treatment with camostat mesilate, H2-receptor antagonist and digestive enzymes. Although the patient abstained from alcohol for approximately 6 months, he resumed drinking, leading to recurrent attacks of pancreatitis. Bromhexine hydrochloride was then administered for 6 months, with the expectation that it would have a mucolytic effect on the pancreatic juice, resulting in improvement in the clinical symptoms, pancreatic enzymes and pancreatic exocrine function, as well as elimination of the protein plug. Bromhexine hydrochloride may be a new therapy for pathological states, such as alcoholic chronic pancreatitis, in which there is increased viscosity of the pancreatic juice because of elevated protein concentration, leading to protein plug formation and temporary blockage of the pancreatic duct.

Therapeutic approaches to mucus hypersecretion

“…The molecular mechanism of action is unclear. In a single anecdotal case report, a mediastinal pancreatic pseudocyst due to intraluminal obstruction of the pancreatic duct was relieved by bromhexine [20].…”

Mediastinal extension of a complicated pancreatic pseudocyst; a case report and literature review

“…Total parenteral nutrition has also been reported to result in resolution of the cyst [7]. Successful resolution of mediastinal pseudocysts with 5-months of therapy with the mucolytic agent bromhexine hydrochloride has also been reported [8]. …”

Pancreatic mediastinal pseudocyst presenting as a posterior mediastinal mass with recurrent pleural effusions: a case report and review of the literature

“…Conservative treatment with strict diet, enzyme supplementation and complete abstinence from alcohol is indicated to all stable patients. In addition, bromhexine hydrochloride and somatostatin analogues have been used in a few cases [ 13 - 15 ]. Somatostatin and its analog octreotide are peptide hormones that inhibit the release of insulin, glucagon, gastrin, secretin, pancreozymin and pepsin.…”