Intrahepatic pseudocyst following acute panceatitis: Report of a case

Abstract

Introduction: Pancreatic pseudocysts are a common complication of acute pancreatitis. Most commonly, pseudocysts are located in the lesser sac and the retroperitoneum. The intrahepatic location of a pseudocyst is a rare event. Herein, we report a case of intrahepatic pseudocyst, located in left hepatic lobe, following acute pancreatitis. Case report: A 70-year-old woman was referred to out hospital with a upper abdominal pain of 3 days' duration. An abdominal CT scan revealed a 11 × 10 cm sized cystic mass in the left lateral section of liver. On EUS findings, a huge hypoechoic lesion was noted with internal echogenicity in the lesser sac. When the cystic lesion was punctured, dark green colored turbid fluid was aspirated. An EUS-guided gastrocystostomy was performed. The cystic fluid analysis showed a high level of amylase in the fluid collection. (21,200 U/L) After the endoscopic procedure, a severe abdominal pain was developed. Physical examination revealed severe tenderness and rebound tenderness. An emergency left hemihepatectomy was performed. On operation findings, a huge cystic tumor was located in the left lateral section of liver. It did not communicated with pancreas or peripancreatic tissue. However, mass-like necrotic tissue was filled with in the hepatoduodenal ligament, hepatogastric ligament, and Glisson sheath of the left hepatic lobe. Pathologic examination confirmed the pseudocyst by proving nonepithelialized granulation tissue of the cystic wall. Conclusion: The presence of intrahepatic cystic lesions in patients with acute pancreatitis should raise the possibility of intrahepatic pseudocysts, even when they are not associated with pancreas or peripancreatic tissue.