A Case of Polycystic Intrahepatic Pancreatic Pseudocyst

A case of intrahepatic pancreatic pseudocyst developed as a complication of pancreatitis

Intrahepatic pancreatic pseudocyst; a rare complication of pancreatitis

Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11x10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.

Intrahepatic pancreatic pseudocyst (wayward cyst): A rare presentation of traumatic pancreatitis

Intrahepatic pancreatic pseudocyst is a very rare differential for a hepatic space occupying cystic lesion. Though pseudocysts complicating chronic calcific pancreatitis are well described , an isolated intrahepatic location is extremely rare. Moreover , Intrahepatic pancreatic pseudocysts are usually described following acute pancreatitis. In this case report we describe the case of a 60 year old male presenting with epigastric pain and abdominal distension, in whom computed tomography showed features of an intrahepatic pancreatic pseudocyst complicating chronic calcific pancreatitis, which was subsequently confirmed on surgery. The etiopathogenesis and the types of intrahepatic pancreatic pseudocysts are discussed in addition to describing the imaging differentials.

A pseudocyst is a well-circumscribed fluid collection surrounded by a non-epithelialized wall of granulation tissue and fibrosis with no associated tissue necrosis that is present for 4 or more weeks after disease onset. Pseudocyst as a complication of acute pancreatitis can occur at any site in the abdomen and even in the mediastinum, but the intrahepatic location of a pancreatic pseudocyst is a very uncommon event. In the literature, only 36 such cases have been described. Computed tomography and high amylase levels obtained by the aspiration of the fluid play an important role in diagnosing this complication. There are no definite guidelines for the management of hepatic subcapsular pseudocyst. We present a case of a 32-year-old male who presented with acute pancreatitis, and radiological imaging was diagnosed with disrupted pancreatic duct and intrahepatic pancreatic pseudocyst in communication with a collection in the anterior abdominal wall.

Pancreatic pseudocyst is a common complication of pancreatitis and is usually located in the peripancreatic space, spleen, and retroperitoneum. An infected intrahepatic pseudocyst following acute on chronic pancreatitis is extremely rare. Here, we report a case of intrahepatic pancreatic pseudocyst with superimposed infection following chronic pancreatitis in a 42-year-old female who presented with severe abdominal pain, vomiting, and bloating sensation. Her labs showed elevated pancreatic enzymes (amylase and lipase), and a provisional diagnosis of acute pancreatitis was made. Imaging revealed a cystic lesion in the left lobe and a calcified pancreas. Endoscopic aspiration of the cystic lesion and pathologic examination confirmed infected intrahepatic pancreatic pseudocyst due to the high serum amylase level and positive Enterococci on culture in aspirated cystic fluid, complicated by chronic pancreatitis.

Introduction Pseudocyst formation is a well known complication of pancreatitis. Intrahepatic pancreatic pseudocyst is very rare event and only about 30 cases have been reported in literature. We report here a case of 32-year-old male who was previously diagnosed as a case of hepatic abscess. He was referred to our department for ultrasonography (USG) and contrast enhanced computed tomography (CECT) abdomen with complaint of recurrent pain in upper abdomen. On the basis of findings of CECT Abdomen, diagnosis of large intrahepatic pancreatic pseudocyst in left lobe of liver is made. Conclusion Intrahepatic pseudocyst should be considered a differential diagnosis of cystic hepatic lesions in the patients with chronic or recent episode of acute pancreatitis. Computed tomography and high level of amylase in the collection plays an important role for diagnosing this complication. How to cite this article Hans P, Tyagi S, Sinha P, Kumar L, Gupta D, Singh R. Rare Case of Intrahepatic Pancreatic Pseudocyst misdiagnosed as Hepatic Abscess. Int J Adv Integ Med Sci 2016;1(4):191-193.

AIMTo investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).METHODSA literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.RESULTSWe found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).CONCLUSIONDiagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.

Intrahepatic Pancreatic Pseudocyst; a Rare Complication of Pancreatitis

We present an extremely rare case of caudate lobe intrahepatic pancreatic pseudocyst with spontaneous rupture into the inferior vena cava (IVC). A 58-year-old male, a chronic alcoholic, presented with features of pancreatitis for which imaging was done. Ultrasound and contrast-enhanced computed tomography were carried out, which revealed intrahepatic pancreatic pseudocyst in the caudate lobe of the liver. There was suggestion of spontaneous rupture of the pseudocyst into the IVC, which was well delineated on imaging.

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Pancreatitis and pseudo-pancreatic cysts are frequently encountered entities; however, intrahepatic pseudocysts presenting as large number of liver cysts with absence of overt signs of pancreatitis has never been reported in literature. Here, we report an interesting case of multiple intrahepatic pancreatic pseudocysts (MIHPPs), a challenging diagnosis to be kept in mind while dealing with complex cystic lesions of liver. Pseudocysts are common complication of pancreatitis, often these are located within the vicinity of the pancreas in the lesser sac and the retroperitoneum. Extra pancreatic location of these cysts within the liver is a diagnosis often missed, with only 50 odd cases reported in literature till date. Most of these reported cases are either subcapsular in location or limited in number to one or two lesions. Although rare, possibility of MIHPPs is an important diagnosis that should be kept in mind while considering list of differentials for complex cystic lesions of the liver even in the absence of overt signs of pancreatitis.

ERCP-associated infected intrahepatic pancreatic pseudocyst

BACKGROUNDIntrahepatic pancreatic pseudocyst (IHPP) is an extremely rare complication of acute pancreatitis, with only a few cases previously described in the literature. To the best of our knowledge, IHPP with Budd-Chiari syndrome (BCS) has not yet been described.CASE SUMMARYA 35-year-old male presented with abdominal pain, vomiting and anorexia, followed by severe swelling of the lower body after 4 d. The morphological assessment (using computed tomography revealed the presence of a huge cyst of 18.28 cm × 10.34 cm under the liver capsule accompanied by a large amount of ascites. Percutaneous puncture allowed us to detect a high level of amylase in the collection, confirming the diagnosis of IHPP. The cyst was treated by percutaneous drainage, producing complete resolution of the cyst.CONCLUSIONIHPP can be treated with percutaneous drainage, endoscopic drainage, surgery or even conservative treatment, depending on the specific condition. We recommend percutaneous drainage as the first choice of treatment when IHPP with secondary BCS.