Abstract
Background and study aims Pseudocysts are the most common pancreatic cystic lesions and they usually develop
in association with pancreatitis of at least 4 weeks’ duration. Extra-pancreatic pseudocysts,
although reported, are relatively uncommon. Secondary liver pseudocysts are recognized
within the literature, and most patients described have required percutaneous or surgical
drainage due to infection or symptoms. The mechanism of hepatic pseudocyst formation
is not entirely clear but it is postulated that this phenomenon may occur through
pseudocyst-portal vein fistulization. We describe two cases of patients presenting
with pancreatic pseudocysts invading the portal venous system with embolization of
pancreatic fluid to the liver and subsequent hepatic pseudocyst formation. Interestingly,
liver pseudocyst resolution was incomplete with antibiotics and percutaneous drainage
alone, and only occurred following endoscopic ultrasonography-guided pancreatic cyst-gastrostomy
and metal stent insertion. We have reviewed the current literature on the diagnosis
and management of pseudocyst-portal vein fistula formation and we believe that our
cases represent the first published within the literature to describe this treatment
approach.
