Pancreatic Pseudocyst Ruptured due to Acute Intracystic Hemorrhage

Abstract

Rupture of pancreatic pseudocyst is one of the rare complications and usually results in high mortality. The present case was a rupture of pancreatic pseudocyst that could be treated by surgical intervention. A 74-year-old man developed abdominal pain, vomiting, and diarrhea, and he was diagnosed with cholecystitis and pneumonia. Three days later, acute pancreatitis occurred and computed tomography (CT) showed slight hemorrhage in the cyst of the pancreatic tail. After another 10 days, CT showed pancreatic cyst ruptured due to intracystic hemorrhage. Endoscopic retrograde cholangiopancreatography revealed leakage of contrast agent from pancreatic tail cyst to enclosed abdominal cavity. His left hypochondrial pain was increasing, and CT showed rupture of the cyst of the pancreatic tail into the peritoneal cavity was increased in 10 days. CT showed also two left renal tumors. Therefore we performed distal pancreatectomy with concomitant resection of transverse colon and left kidney. We histopathologically diagnosed pancreatic pseudocyst ruptured due to intracystic hemorrhage and renal cell carcinoma. Despite postoperative paralytic ileus and fluid collection at pancreatic stump, they improved by conservative management and he could be discharged on postoperative day 29. He has achieved relapse-free survival for 6 months postoperatively. The mortality of pancreatic pseudocyst rupture is very high if some effective medical interventions cannot be performed. It should be necessary to plan appropriate treatment strategy depending on each patient.

A Case of Spontaneous Intraperitoneal Rupture of an Acute Necrotic Fluid Collection Associated with Necrotizing Pancreatitis

“…Fistula formation may be associated with symptoms that include diarrhea, hematochezia, or hematemesis depending on the fistula location and whether there is erosion into adjacent blood vessels [7]. The mechanisms associated with rupture and hemorrhage include the activation of lytic pancreatic enzymes that digest and disrupt the adjacent wall of a hollow viscus and blood vessels, compression of adjacent organs that results in local ischemia, and and localized compression of the portal or splenic vein resulting in portal hypertension with hemorrhage [7,9]. The symptoms and location of the fistula determine surgical management, as gastric and enteric fistulas have a high rate of spontaneous closure, while duodenal and colonic fistulas are more likely to require surgical intervention for definitive management [10].…”

Transcatheter embolization of anticoagulation related pancreatic pseudocyst hemorrhage: A case report

“…Hemorrhage associated with acute and chronic pancreatitis is a well-known complication with a mortality rate of up to 40% [5], [6], [7]. Rates of hemorrhage vary across multiple studies, ranging from 1%-31% [5].…”

“…Management of ruptured and hemorrhagic pancreatic pseudocysts, however, has previously been thought to be almost exclusively surgical [7]. Even when endovascular treatments are considered, they are often used as a stabilizing procedure prior to surgery [6], [8]. Postsurgical mortality rates associated with both hemorrhagic pancreatic pseudocysts and pseudoaneurysms are very high, ranging from 20% to 43% [5], [9], [10].…”

Pancreatic pseudocyst treated by laparoscopy, case report

“…The presentation begins 4 to 6 weeks after the pancreatitis event and begins with symptoms like abdominal pain, postpandrial plenitude, sometimes loss of weight, and in 5% of the cases it is presented with some complications like hemorrhage, infection, rupture and peritonitis signs. 3,4 The drainage of this lesions is indicated when the symptoms persist more than 6 weeks, when the cyst is larger than 6cm in diameter, is rapidly enlarging or some complication is present. 4,5 The options for drainage include endoscopic function, open surgical drainage with cystogastrostomy, cystoduodenostomy and Rouxen-Y cystojejunostomy, or these techniques with minimally invasive approach by laparoscopy.…”

“…2 In the other 15% of cases the endoscopic or surgical drainage is necessary to avoid significant complications associated like hemorrhage, rupture or splenic vessels thrombosis. 3 …”