Clin Endosc.  2021 Sep;54(5):763-766. 10.5946/ce.2020.279.

Successful Endoscopic Ultrasound-Guided Treatment of a Spontaneous Rupture of a Hemorrhagic Pancreatic Pseudocyst

• Park C
• Kim TH
• Chon HK

• KMID: 2520562
• DOI: http://doi.org/10.5946/ce.2020.279

Abstract

Spontaneous rupture of a hemorrhagic pancreatic pseudocyst may be life-threatening. Endoscopic ultrasound (EUS)-guided drainage has been reported to be a valuable treatment option for pancreatic pseudocysts. However, its usefulness in the management of a ruptured pancreatic pseudocyst is limited. We report a rare case of a spontaneous rupture of a hemorrhagic pancreatic pseudocyst in a patient with chronic pancreatitis, which was successfully treated with EUS-guided gastrocystostomy with a fully covered self-expandable metallic stent.

Keyword

Endoscopic ultrasound; Gastrocystostomy; Pancreatic Pseudocyst

Figure

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  Fig. 1. (A) Axial T2-weighted magnetic resonance imaging showing the main pancreatic duct dilation (open black arrow) with multiple pancreatoliths (black arrowheads) and a pseudocyst (open white arrow), about 9 cm in size, in the pancreatic tail. Abdominal computed tomography scan of a hemorrhagic pancreatic pseudocyst that ruptured spontaneously. (B) Axial and (C) coronal views showing mural discontinuity (black arrows) of the hemorrhagic pancreatic pseudocyst (asterisks), extension of fluid into the perisplenic space (white arrows), and multiple main pancreatic duct stones with pancreatic atrophy.

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  Fig. 2. Endoscopic ultrasound-guided gastrocystostomy. (A) Large anechoic cystic lesion with hyperechoic material on endoscopic ultrasound, (B) The pseudocyst was punctured with a 19-gauge needle for fine-needle aspiration (white arrowhead). (C) Passage of a 0.025-inch guidewire under fluoroscopic guidance, (D) Placement of a metal stent with a nasocystic drainage tube, and (E) Endoscopic view showing gushing thick and turbid bloody fluid gushing out, and the presence of the metal stent.

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  Fig. 3. Abdominal computed tomography scan showing complete resolution of the ruptured pancreatic pseudocyst with the metal stent (black arrow) on axial (A) and coronal (B) views.

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