Mediastinal pancreatic pseudocyst naturally drained by esophageal fistula

Abstract

Mediastinal pancreatic pseudocyst is a rare complication of acute or chronic pancreatitis. Pleural effusion and pneumonia are two of the most common thoracic complications from pancreatic disease, while pancreaticopleural fistula with massive pleural effusion and extension of pseudocyst into the mediastinum is a rare complication of the thorax from pancreatic disease. To the best of our knowledge, there have been no case reports of mediastinal pancreatic pseudocyst-induced esophageal fistula in Korea to date. Here in, we report a case about 43-year-old man of mediastinal pancreatic pseudocyst-induced esophageal fistula presenting with chest pain radiating toward the back and progressive dysphagia. The diagnosis was confirmed by an esophagogastroduodenoscopy and abdomen computed tomography (CT). The patient was treated immediately using a conservative method; subsequently, within 3 days from treatment initiation, symptoms-chest pain and dysphagia-disappeared. In a follow-up gastroscopy 7 days later and abdomen CT 12 days later, mediastinal pancreatic pseudocyst showed signs of improvement, and esophageal fistula disappeared without any complications.

Pseudocyst of the pancreas masquerading as spontaneous pneumomediastinum

“…However, it is worth noting the severe implications with 29–39% of deaths from pancreatitis attributable to pulmonary complications [ 2 ]. If not recognized TPP may have disastrous complications, including: pneumonia, empyema, tamponade, pseudoaneurysm, oesophageal perforation, massive haemoptysis and Bronchopleural fistula [ 1 , 6 , 7 ].…”