A Case of Mediastinal Pancreatic Pseudocyst Successfully Treated with Somatostatin Analogue

Abstract

A 57-year-old man with a 3-year history of chronic pancreatitis was admitted to our hospital with upper abdominal pain. Based on examination findings, the patient was diagnosed as having pseudocysts in the pancreatic body and the mediastinum that were associated with acute aggravation of chronic pancreatitis. Because of the patient refused an operation, he was submitted to conservative management including intramuscular injection with somatostatin analogue of 100 microg/day. On the 14th day of the treatment, pleural effusion and pseudocyst in the pancreatic head were additionally diagnosed based on the findings of computed tomography, magnetic resonance imaging and other examinations, and the dose of somatostatin analogue was increased to 200 microg/day. As a result, on the 28th day of the treatment, pancreatitis was inactivated, and the pseudocysts in the mediastinum and the pancreas disappeared. The patient has been followed up for 15 months, and there has been no recurrence.

An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings

“…Once in the retroperitoneum, fluid collections track along the path of the least resistance [8]. In the majority of patients, the fluid enters the mediastinum through the aortic hiatus or the esophageal hiatus [4–9] and, thus, mediastinal fluid collections are commonly located in the posterior mediastinum [5, 6, 8]. …”

Somatostatine analogue in nonoperative treatment of posttraumatic pancreatic pseudocyst in a child: a case report

“…In experimental and acute pancreatitis, somatostatin and octreotide were effective in preventing complications of pancreatic operations and in the therapy of fistulas and pseudocysts [12]. No consensus has been reached in regards to use and the appropriate dosage of somatostatin analogues [10]. We described the nonoperative treatment of pancreatic pseudocyst with somatostatine analogue, octreotide acetate.…”

“…In our patient, nonoperative treatment of pancreatic pseudocyst was continued with analgesics, antiemetics, low fat diet and somatostatin analogue, octreotide acetate. The rationale of using octreotide as a therapy for pancreatic pseudocyst is that it will decrease pancreatic secretions and aid in pseudocyst resolution [10]. Yasuda et al had found that somatostatin or its analogues have been used in nonoperative treatment of pancreatic pseudocyst, but this usually requires prolonged therapy [11].…”

“…Somatostatin affect the exocrine function both directly, by reducing the secretion of digestive enzymes and indirectly, by inhibiting secretin and cholecystokinin production. Octreotide is a somatostatin analog that possesses the same pharmacological properties as somatostatin, and recent studies reported clinical efficacy of somatostatin analogues in the conservative treatment of pediatric pancreatic pseudocyst, that is refractory to other conservative treatment modalities [10]. In experimental and acute pancreatitis, somatostatin and octreotide were effective in preventing complications of pancreatic operations and in the therapy of fistulas and pseudocysts [12].…”

Pancreatic Pseudocyst: Therapeutic Dilemma

“…The rationale of using octreotide as a therapy for pancreatic pseudocyst is that it will decrease pancreatic secretions and aid in pseudocyst resolution. Unfortunately, this strategy has not been rigorously tested and only a handful of case series have been published [22, 23]. …”