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Laparoscopic Cystogastrostomy in the Management of Pancreatic Pseudocysts

Abdihakin M1, Kinyua J2

  1. Aga Khan Hospital, Mombasa

  2. Coast Provincial General Hospital, Mombasa

Correspondence to: Dr. John Kinyua, P.O Box Private Park, Mombasa.

Email: johnkinyua@gmail.com

Summary

Pancreatic pseudocysts develop following acute or chronic pancreatitis. Majority of the cases resolve spontaneously but some persist beyond six weeks. Active management of pancreatic pseudocysts involves draining of the fluid collection through open surgery, endoscopically, laparoscopically or percutaneously. In our setup, drainage has traditionally been done through open surgery. In this article we present a case of a 61 year old male who developed pancreatic pseudocysts secondary to chronic pancreatitis. Laparoscopic cystogastrostomy was performed and there was no recurrence after three months of follow up. The case presentation highlights the need to offer laparoscopic cystogastrostomy as a method of managing pancreatic pseudocysts in our setup.

 

Keywords: Pancreatic Pseudocyst, Cystogastrostomy, Laparoscopic Drainage.

Ann Afr Surg. 2016;13(1):39-41.

Introduction

Pancreatic pseudocysts are collections of peri-pancreatic fluid enclosed in a wall of inflammatory and fibrous tissue. It is called a pseudocyst because it lacks epithelial tissue on the inner surface of the cyst wall. Pancreatic pseudocysts appear 5-6 weeks into the course of acute pancreatitis and in chronic pancreatitis (1).

The natural course of pancreatic pseudocysts involves spontaneous resolution after 4 to 6 weeks in 85% of the cases (2). Active management is however required if they persist, are larger than 6cms or are symptomatic (2). Complications of these pseudocysts include infection, rupture and bleeding seen in 30-50% of the cases, and the probability of spontaneous resolution is low (2).

Minimally invasive techniques such as laparoscopic and endoscopic drainage have been developed and are gaining popularity due to reduced risk of complications and favorable results (3,4). A case of symptomatic pseudocysts in a 61 year old following chronic pancreatitis managed laparoscopically is discussed.

 

Case Report

A 61 year old male patient presented to the emergency department with a three year history of intermittent abdominal pain. The pain was progressively increasing in severity and intensity. It was localized to the epigastric region and was exacerbated by feeding. One week prior to presentation to our facility, he had noted a mass over the same area which was also gradually increasing in size. He also reported naus