Successful resolution of delayed perforation after insertion of Lumen-apposing metal stent (LAMS) in a pancreatic pseudocyst

Pancreatic pseudocysts, a common complication of acute pancreatitis, can lead to severe outcomes such as infection, bleeding, or, rarely, rupture, potentially resulting in peritonitis and sepsis requiring urgent treatment. Management often involves minimally invasive drainage, with surgery for severe cases.

In this case, A 42-year-old male with a history of heavy alcohol use and acute pancreatitis presented with severe epigastric pain. 3 weeks before admission, CT showed a significant increase in the pseudocyst size compared to 3 months ago, causing recurrent abdominal pain. He underwent endoscopic ultrasound-guided gastrocystostomy (LAMS placement) 2 weeks ago and was discharged without complications.

On presentation, imaging revealed a perforated pancreatic pseudocyst with peritonitis, and septic shock was diagnosed. He was treated with antibiotics and percutaneous drainage, and although his condition was initially stable, his catheter required replacement 6 times due to persistent fluid collections. Five weeks after LAMS insertion, an upper gastrointestinal series revealed enteric fluid leakage. The LAMS was removed, and the fistula was successfully closed using endoscopic clips. He gradually improved, and the final drain was removed on hospital day 42. He remains asymptomatic under outpatient follow-up [1] [2].

This case represents a rare instance of pseudocyst rupture on the opposite wall occurring two weeks after LAMS insertion, which was successfully managed with minimally invasive interventions and antibiotics.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Habashi S, Draganov PV.. Pancreatic pseudocyst. World J Gastroenterol 2009; 15 (1): 38-47
• 2 Bang JY, Varadarajulu S.. Lumen-apposing metal stents for endoscopic ultrasonography-guided interventions. Dig Endosc 2019; 31 (6): 619-626