Percutaneous transgastric cystoduodenostomy in the treatment of a pancreatic pseudocyst: A new approach

Abstract

A case of an infected pseudocyst in the head of the pancreas is presented. Due to its small size and fistulization to the duodenum, a drainage catheter was placed through the fistulous tract from a distant transgastric approach. The fistula was balloon dilated to improve its emptying. Sixteen months later the patient remains asymptomatic with no recurrence of the pseudocyst.

Multidisciplinary Management of Complicated Pancreatitis: What Every Interventional Radiologist Should Know

“…Rarely, a transgastric approach with passage of a percutaneous drain through the stomach could help subsequent internalization with a double pigtail tube, particularly for long-term drainage (e.g. pancreatic duct fistula) [81,82]. Prior to the procedure, patients should be informed that they may need more than one catheter and prolonged duration of drainage for several weeks to months [71,83].…”

“…The risk of persistent pancreaticocutaneous fistula after drain removal is associated with severity of pancreatitis, with a frequency as high as 32% in patients with infected necrotic pancreatitis [80,83]. This risk is decreased by a transgastric approach or simultaneous combined endoscopic drainage [11,77,[80][81][82].…”