Transdiaphragmatic Cyst—Jejunostomy with Roux-En-Y Loop for An Exclusively Mediastinal Pancreatic Pseudocyst:Case Report

Abstract

In a patient presenting with a roentgenographic retrocardiac density, left pleural effusion and distal oesophageal displacement, echocardiography confirmed presence of a pseudocyst in the posterior mediastinum. Pancreatic origin was suspected. Left thoracolaparotomy revealed the large (900 ml), exclusively mediastinal pseudocyst, surrounding the aorta and adherent to the diaphragm, with high amylase content. Decompression was achieved with a retrocolic and gastric Roux-en-Y loop by transdiaphragmatic cystojejunostomy.

Pancreatic Pseudocysts in the Mediastinal Space: An Urban Legend?

“…The approach is less defined for migrated pancreatic pseudocysts as they occur very rarely. Cases of spontaneous remission have been reported after initiation of total parenteral nutrition, and some patients have been successfully treated with octreotide therapy, but often percutaneous, endoscopic or surgical drainage is required [8–11] . Thoracotomy is usually needed for mediastinitis, but only a few cases of thoracoscopic drainage of mediastinitis secondary to pancreatic pseudocyst have been described [12] .…”

Mediastinal Pancreatic Pseudocyst With Acute Airway Obstruction

“…26,27 Finally, surgical treatment, including laparoscopic operations, is usually reserved for cases that fail to resolve by other measures. 20 The operation may consist of external drainage, internal drainage, or excision depending upon the case. Surgical options are highly successful, with recurrence rates of less than 10% 11,28,29 and mortality rates of less than 5%.…”

“…3,7,8,18,19 Unlike peripancreatic pseudocysts, spontaneous regression of mediastinal pancreatic pseudocysts is rare. 4,20 This clearly may be a result of preferential reporting of complicated cases of mediastinal pseudocysts.…”

Three cases of mediastinal pancreatic pseudocysts

“…Surgical treatment should be performed for patients with failure of the abovementioned less-invasive therapies, as well as patients with bleeding, infection, pseudocyst rupture, and acute life-threatening presentations. Surgical options include internal drainage, external drainage, cyst-enterostomy, or pancreatic resection ( 21 , 22 ). In our three cases, CT and MRI were useful imaging modalities for evaluating the MPD diameter, the site of stenosis, the length of stricture, and the size and location of the pseudocysts.…”