English

Abstract

Pseudo cyst is a collection of amylase rich fluid enclosed in a wall of granulation or fibrous tissue in the lesser sac. Pseudo cyst is unilocular and has no epithelial lining. Pseudo cyst typically arises following an attack of acute pancreatitis, but can develop in patients with chronic pancreatitis (25%) or after pancreatic trauma. Pseudo cyst is more commonly seen in males, between the age of 30-40 years, Alcohol abuse is the major risk factor for the development of pseudo cyst. Reported here is a case of pseudo cyst of pancreas in a 51 year old male patient. INTODUCTION: Pseudo cyst account for 90% of all cystic collections associated with pancreas. Pseudo cysts are more commonly seen in males between the age group 30-40 years. It is followed by an attack of acute or chronic pancreatitis and are most common in alcoholic chronic pancreatitis. This unilocular cyst is a collection of amylase rich fluid enclosed in a wall of granulation or fibrous tissue. Communication between cyst and pancreatic duct are seen in 70% of cases. In this article, a case is reported of a pseudo cyst of pancreas in a 51 year old male. This article seeks to highlight the diagnostic dilemma posed by the present case due to its atypical presentation. CASE SUMMARY: 51 year old male patient, chronic alcoholic and chronic smoker presented with hiccup, chest heaviness and nausea for the past 2 weeks. Patient had a history of cysto gastrostomy done for pseudo cyst of pancreas 10 year back. No significant medical or family history. On respiratory system examination there is reduced vocal fremitus dull note in percussion reduced vocal resonance and breath sounds in the left lower zone of chest. Other systems are within normal limits. Routine blood investigations, LFT, RFT, serum amylase, GGT, and TSH do not give any diagnostic clue. Chest x-ray shows n air - fluid level in the left lower zone chest. A provisional diagnosis of left hydro pneumothorax was made. The diagnosis of pseudo cyst of pancreas is made through USG abdomen & confirmed by CT scan. CT showed - A large cyst measuring 13x12x11 cm is seen in the left side which appears to be arising from the region of the tail of pancreas. The fluid within the cyst is homogenous with air fluid level. Cyst wall is well defined smooth and shows areas of calcification. Patient underwent exploratory laparotomy. During the surgery we could not find out the cystic mass. But there was a retroperitoneal fullness near the lesser curvature of stomach. Needle aspiration through this area did not give any fluid. But aspiration through this area did not give any fluid. But aspiration through the stomach gave pus. To approach the collection, gastrostomy was done, which gave about 100 ml of pus in the stomach. This might be because of rupture of cyst into the stomach just before operation. Gastrostomy was put to drain the pus. This patient had an uneventful post-operative period. Patient was recovered from the illness.