Retroperitoneal and mediastinal pancreatic pseudocyst accompanied by pancreas divisum

Akira Yasuda, Kaori Watanabe, Shiro Fujihata, Takahiro Watanabe, Kenichi Nakamura, Minoru Yamamoto, Hidehiko Kitagami, Yasunobu Shimizu, Tetsushi Hayakawa, Moritsugu Tanaka

Research output: Contribution to journalArticle

Abstract

A 68-year-old man with a history of alcoholism was seen in the clinic for dyspnea on exertion. Chest X-ray showed a large right pleural effusion. He was admitted to our hospital. Amylase level in the effusion was elevated, and plain CT demonstrated a retroperitoneal and mediastinal low density area and multiple calcifications in the pancreas. Enhanced CT after drainage of the pleural effusion revealed that the low density area was a cystic lesion, and the lesion grew to a large size. A cluster of small pancreatic pseudocysts in the pancreatic tail and body were noted. We diagnosed a pancreatic pseudocyst of the mediastinum and retroperitoneum, and pancreatic pleural effusion secondary to chronic pancreatitis. An internal fistula between the pancreatic pseudocysts and the cystic lesions in the retroperitoneal space was suspected by MRCP. The fistula was not recognized by ERCP because of pancreas divisum. Distal pancreatosplenectomy was performed and the mediastinal pancreatic pseudocyst disappeared on CT four months postoperatively. MRCP was an effective tool to diagnose an internal fistula in a patient with pancreas divisum.

Original languageEnglish
Pages (from-to)517-523
Number of pages7
JournalJapanese Journal of Gastroenterological Surgery
Volume49
Issue number6
DOIs
Publication statusPublished - 01-01-2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

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