Inpatient Management and Treatment of a Giant Pancreatic Pseudocyst: A Case Report

Abstract

Pancreatic pseudocyst formation is a common sequela of pancreatitis caused by alcohol use or gallstones. Giant pancreatic pseudocyst is an infrequently reported but serious complication of pancreatitis. Due to the large volume of pancreatic fluid containing active enzymes, giant pancreatic pseudocysts may require surgical intervention. We report a case of a giant pancreatic pseudocyst in a 56-year-old-female with a history of heavy alcohol use presenting with shortness of breath, general malaise, and dyspnea on exertion. Initial computed tomography (CT) scan demonstrated a giant pancreatic pseudocyst measuring up to 22 cm in the largest diameter. The patient was hospitalized, and an endoscopic cystogastrostomy was performed. Once the patient was stabilized, the cystogastrostomy stent was removed and replaced with a pigtail catheter. CT scan at three-month follow-up demonstrated no evidence of fluid re-accumulation. Due to the large size of giant pancreatic pseudocysts, drainage of the pseudocyst is the most appropriate treatment. There are different treatment modalities to achieve the goal of draining pseudocysts. One of the most commonly used treatments is an endoscopic ultrasound-guided cystogastrostomy, which this case highlights as an acceptable treatment option for giant pancreatic pseudocyst.