1021 Spontaneous Rupture of Haemorrhagic Pancreatic Pseduocyst – Case Report

Abstract

Abstract Case Study A 67-year-old male presented to the emergency department with sudden onset of diffuse abdominal pain, nausea, and vomiting. Relevant surgical history He has a history of choledocholithiasis, and he was treated for an episode of acute gallstone related pancreatitis twelve months ago. He underwent ERCP in the admission. He subsequently developed a pancreatic pseudocyst which was managed conservatively through watchful waiting. Examination He was particularly tender in the epigastric region. He was mildly tachycardic and normotensive. Imaging CT Abdomen and Pelvis demonstrated a significantly enlarged pseudocyst which is closely applied to multiple branches of the coeliac axis. Haematoma within the left upper quadrant was compatible with recent haemorrhage. Management The patient was initially managed with IV fluids, broad spectrum IV antibiotics, analgesia, and anti-emetics. He needed emergency surgery for definitive management. Central pancreatectomy and peritoneal toilet were carried out. Pancreatic bed drains were left in-situ for two weeks. Patients need to spend one day in Intensive care. He was fed through TPN initially before switching to nasogastric feeding. Patient was discharged two weeks post-op with Octreotide and fortisips. Discussion Pancreatic pseudocyst is a common complication of pancreatitis. Spontaneous rupture of a pseudocyst is rare occurrence as a result it appears sporadically in the medical literature. However, it can be a potentially serious leading to severe peritonitis and needs emergency surgical exploration as highlighted in this case. Prompt surgery combined with extensive lavage was life saving for this patient.