A ruptured pancreatic pseudocyst causes acute peritonitis with clinical characteristics of a gastrointestinal tract perforation

Abstract

Intraperitoneal air in pancreatic pseudocysts is a rare complication that can jeopardize hemodynamic stability and requires emergency surgery. A 61-year-old man was admitted to our hospital after abdominal pain, vomiting and diarrhea. Computed tomography showed a hollow visceral perforation with intraperitoneal air and two pseudocysts close to the pancreas. The patient was transferred to the emergency operating room with symptoms of septic shock. We histopathologically diagnosed a ruptured pancreatic pseudocyst combined with an intracystic haemorrhage. We resected a portion of the pseudocyst wall using surface electrocautery inside the lumen, cholecystectomy and peritoneal toilet and maintained adequate external drainage. The patient was discharged on postoperative Day 12. The patient achieved relapse-free survival for 12 months postoperatively. Ruptured pancreatic pseudocysts with extraluminal gas are dangerous if effective medical interventions are not performed. Emergency surgery should be completed as soon as possible to drain the pancreatic cyst and cleanse the abdomen.

Perforation of pancreatic pseudocyst diagnosed with endoscopy and treated with percutaneous drainage

“…Most case reports of perforated pancreatic pseudocysts rely on CT scans for diagnosis, which typically show a significant amount of free fluid and air in the peritoneal cavity. Additionally, physical examination findings indicative of peritonitis such as abdominal tenderness and guarding, along with signs of systemic inflammation and hemodynamic instability, can aid in the diagnostic process 2 . In this particular case, mild hemorrhagic ascites were already observed in the initial CT scan before the EUS examination, suggesting a spontaneous perforation of the pseudocyst upon admission.…”

“…Spontaneous perforation of a hemorrhagic pancreatic pseudocyst is an exceedingly rare complication, but it can be extremely fatal if not managed promptly and properly. The perforation can either occur in the gastrointestinal tract lumen or the peritoneal cavity 2 . Rupture into the gastrointestinal tract may lead to spontaneous regression of the pseudocyst as the pancreatic fluid is effectively drained and eliminated through the digestive system.…”

“…However, recent reports have suggested that both endoscopic ultrasonography (EUS)‐guided and percutaneous drainages are viable treatment options for perforated pseudocysts. 2 We present a rare case of spontaneous perforation of a pancreatic pseudocyst identified by endoscopy and successfully managed by endoscopic and percutaneous drainage.…”

Spontaneous rupture of an infected pseudocyst of the pancreas: A case report

“…Laparotomy is the gold standard treatment. In the absence of peritonitis, the ideal surgical option is the drainage of the cyst to the gastrointestinal tract [12] . However, local conditions with important inflammation and generalized peritonitis make it impossible to perform the anastomosis [13] .…”

“…Otherwise, the drainage should be retained longer to treat the pancreatic leakage. The drainage of the cyst to the gastrointestinal tract via cysto-gastrostomy or cysto-duodenostomy can be planned in case of the persistence of the pancreatic fistula [12] , [14] .…”