Mediastinal pancreatic pseudocyst

Abstract

Among previous cases of mediastinal pseudocyst requiring surgical decompression, all but one had been found at surgery to occupy a position both in the mediastinum and in the upper abdomen. In the present case, although preoperative ultrasound and CT scans suggested that the pseudocyst was straddling the diaphragm, an abdominal portion could not be found at surgery, and the pseudocyst was drained successfully through the diaphragm by a Roux-en-Y loop of jejunum. Because ultrasound and CT scan may not be able to determine the precise relationship of a mediastinal pseudocyst to the diaphragm and the availability of the lower portion of the pseudocyst for surgical decompression, an endoscopic retrograde cholangiopancreatography is strongly recommended as part of the preoperative evaluation.

Mediastinal pancreatic pseudocyst following traumatic rupture of diaphragm

“…Clinical and radiological features of mediastinal pancreatic pseudocysts are well documented [4,5]. Manage-* Formerly pool officer in Radiology, Safdarjang Hospital, present address-lecturer, Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi a n d V. N a t h BaijaP Hospital, New Delhi, India ment is, however, still controversial.…”

“…Manage-* Formerly pool officer in Radiology, Safdarjang Hospital, present address-lecturer, Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi a n d V. N a t h BaijaP Hospital, New Delhi, India ment is, however, still controversial. External o r internal decompression including Roux-en-Y loop have also been described [4]. External o r internal decompression including Roux-en-Y loop have also been described [4].…”

“…If suspected, mediastinal pseudocysts can be localized by Computed tomography with sagittal reconstruction [4]. A high index of clinical suspicion and careful interpretation of plain films and barium studies may help in pre-operative suspicion of mediastinal pseudocyst.…”

“…Of the 35 reported mediastinal pseudocysts, only three were seen in children [1][2][3]. In retrospect, in the presence of blunt abdominal trauma, a persistent left pleural effusion and an extrinsic mass impression on the lesser curvature of the herniated stomach should have made us suspect an underlying pancreatic pathology.Clinical and radiological features of mediastinal pancreatic pseudocysts are well documented [4,5]. We report an additional pathway through a traumatic defect in diaphragm.…”

Endotherapy for Complications of Pancreatitis: Ready for Prime Time

“…Traditional management of pancreatic fluid collections, such as the one presented by Musana et al 3 has been medical 4 and/or surgical, 5,6 and occasionally radiological (percutaneous). [7][8][9] Although endoscopic therapy for this complication has been previously described, [10][11][12] surgery remains the gold standard for interventional therapy of pancreatic disease by which other therapies are judged.…”