Management of patient with a ruptured pancreatic pseudocyst at Ndola Teaching Hospital, Zambia: Case report and literature review

Abstract

A pancreatic pseudocyst (PP) is a localized collection of pancreatic juice in pancreatic tissue or peripancreatic space reach, in amylase and other enzymes, surrounded by a cyst wall composed of fibrous wall or granulation tissue, and a cyst wall lacking epithelium. A PP develops after acute pancreatitis, chronic pancreatitis, pancreatic trauma, or obstruction of the main pancreatic duct. PP commonly presents with symptoms of abdominal pain, early satiety, nausea and vomiting in the setting of an abdominal mass. Diagnosis is based on clinical and laboratory tests (persistent high levels of amylase) and on imaging by abdominal ultrasound or computer tomography (CT) scan of a persistent pancreatic fluid collection present for at least 4 weeks. Pseudocysts cannot be removed until 6 weeks after an episode of pancreatitis, to allow the walls to thicken to at least 6mm and the pseudocyst to grow to at least 6cm in size; however, pseudocyst   formation is difficult to date. We present a patient who had a ruptured PP and therefore underwent emergency laparotomy. The cyst wall was immature and therefore a cystenterostomy was not possible. PP excision was chosen because the PP was already ruptured and had dense immature cyst-bowel adhesions, a thin wall and absence of abnormality of pancreatic main duct; in addition, expertise was  available. Our patient recovered well without complications in the 90-day follow-up and was subsequently discharged.