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Complicated traumatic pancreatic pseudocyst: a case report
Abstract
Background: Pancreatic pseudocyst is uncommon especially in a society where alcoholic beverages are forbidden by culture and religion. Accordingly, when it occurs it is most often misdiagnosed and surgical improvisation is inevitable. It is advised that these expediencies in surgery are reported for the guidance of other workers who find themselves in a similar position.
Methodology: The presentation, operative procedure and outcome of the patient with proven traumatic pancreatic pseudocyst managed at the Usmanu Danfodiyo University Teaching Hospital [UDUTH], Sokoto, Nigeria formed the basis of this report.
Result: A 22-year old male commercial driver sustained blunt abdominal injury from the steering wheel following road traffic accident. He subsequently developed severe epigastric pain and tenderness, passage of melaena stools and unresolving episodic haematemesis. He also had bilateral pitting pedal swellings, more on the left leg that persisted despite aggressive conservative management. The diagnosis of pancreatic pseudocyst was established intra-operatively. Transgastric cystogastrostomy was performed. The post-operative recovery was speedy, uneventful and with complete resolution of all previous symptoms and signs including the bilateral pitting leg swellings. He was discharged in a stable clinical condition on the 10th post-operative day after all sutures were removed.
Conclusion: Traumatic pancreatic pseudocyst is rare, with the possibility of curious presentations, which in our case included bilateral pitting pedal oedema. Failed conservative management is an indication for a prompt surgical intervention. The appropriate internal drainage procedure such as transgastric cystogastrostomy provides an effective and rapid means of cure.
Keywords: trauma, complicated pseudocyst, pedal oedema, open transgastric cystogastrostomy
Sahel Medical Journal Vol. 8(4) 2005: 110-113
Methodology: The presentation, operative procedure and outcome of the patient with proven traumatic pancreatic pseudocyst managed at the Usmanu Danfodiyo University Teaching Hospital [UDUTH], Sokoto, Nigeria formed the basis of this report.
Result: A 22-year old male commercial driver sustained blunt abdominal injury from the steering wheel following road traffic accident. He subsequently developed severe epigastric pain and tenderness, passage of melaena stools and unresolving episodic haematemesis. He also had bilateral pitting pedal swellings, more on the left leg that persisted despite aggressive conservative management. The diagnosis of pancreatic pseudocyst was established intra-operatively. Transgastric cystogastrostomy was performed. The post-operative recovery was speedy, uneventful and with complete resolution of all previous symptoms and signs including the bilateral pitting leg swellings. He was discharged in a stable clinical condition on the 10th post-operative day after all sutures were removed.
Conclusion: Traumatic pancreatic pseudocyst is rare, with the possibility of curious presentations, which in our case included bilateral pitting pedal oedema. Failed conservative management is an indication for a prompt surgical intervention. The appropriate internal drainage procedure such as transgastric cystogastrostomy provides an effective and rapid means of cure.
Keywords: trauma, complicated pseudocyst, pedal oedema, open transgastric cystogastrostomy
Sahel Medical Journal Vol. 8(4) 2005: 110-113
