Successful treatment of mediastinal pancreatic pseudocyst and pancreatic pleural effusion with endoscopic pancreatic duct drainage: A case report

Abstract

An 81‐year‐old man with chronic pancreatitis was being treated with a protease inhibitor. He developed an acute exacerbation of chronic pancreatitis and dyspnea. Contrast‐enhanced computed tomography showed disruption of the main pancreatic duct, a cystic lesion connecting the mediastinum to the main pancreatic duct, and left pleural effusion. We diagnosed a pancreatic pseudocyst, mediastinal pancreatic pseudocyst, and pancreatic pleural effusion. Endoscopic retrograde pancreatography showed leakage of contrast medium from the pancreatic body; furthermore, a cystic cavity extending to the mediastinum through a pancreatic duct fistula was visualized. An endoscopic transpapillary nasopancreatic drainage tube was placed in the cystic cavity. Computed tomography showed that the mediastinal pseudocyst and pleural effusion had disappeared. Endoscopic transpapillary pancreatic duct drainage may be useful when a connection between the main pancreatic duct and a mediastinal pseudocyst is confirmed by imaging.

Endoscopic Nasopancreatic Drainage Contributes to Early Resolution of Postgastrectomy Gastropancreatic Fistula

“…The treatment of a postoperative pancreatic fistula requires drainage of the pancreatic juice. ENPD is reportedly effective for mediastinal pancreatic pseudocysts and pancreatic effusion in chronic pancreatitis caused by pancreatic juice leakage ( 1 ). In the present case, the pancreatic leakage resolved in one week, despite the large size of the fistula, owing to the efficacy of ENPD in reducing the exposure of the Billroth I anastomotic ulcer to pancreatic juice via intragastric reflux.…”

“…While conservative treatment is recommended in most cases, reoperation may be needed. Endoscopic nasopancreatic duct drainage (ENPD) is effective for treating pancreatic duct disruption caused by acute pancreatitis, pseudopancreatic cysts, and postoperative pancreatic effusion ( 1 ).…”

The Role of Endoscopic Ultrasound in the Interventional Management of Mediastinal Collections: A Narrative Review

“…Table 8 shows abdominal lesions with mediastinal extension treated using endoscopic approach [20,21,24,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]. The main etiology of the lesions was pancreatic pseudocyst, which, as noted above, constitutes a minor but feasible extension.…”

“…Table 8 shows abdominal lesions with mediastinal extension treated using endoscopic approach [ 20 , 21 , 24 , 52 - 66 ].…”