Summary
This paper reports on a patient who was treated by percutaneous aspiration, instillation
of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic
pseudocyst. Five weeks after admission to hospital for the first episode of an acute
necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided
puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent
fluid collection led to a second puncture, combined with the injection of polidocanol
(15 ml; 1 %) info the cyst cavity. Since this treatment failed, a percutaneous cystogastric
drain (“double-pigtail”) was inserted five days later. After developing acute abdominal
pain and incipient sepsis, the patient was sent for surgical intervention twelve days
after the second treatment with percutaneous aspiration and injection of polidocanol.
During the operation an infected pancreatic pseudocyst with extensive contaminated
necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed,
followed by continuous lavage of the omental bursa. Intensive care therapy was necessary
for one week. Duodenal leakage persisted for nearly three weeks, then stopped spontaneously.
The patient was discharged in quite a good state of health after 33 days of postoperative
treatment. Although spontaneous development of infected pancreatic pseudocysts and
pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement
of the drainage procedures, especially in combination with the injection of a sclerosant
must be considered.
Key words:
Pancreatic pseudocyst - Drainage, cystogastric - Complications - Sclerosants
