A 29 year-old male patient complains: for
six months bloating of the abdomen, non deep ache, difficulty in
eating and digesting food and having a mass of 150x200mm in his epigastric
region. He had a trauma of epigastric region by traffic accident seven months
ago and had been operated for it.
Ultrasound examination : Cross-sectional
images of the mass in epigastric
region. It was a large anechoic mass with posterior acoustic enhancement,
smooth contour, unilocular, no Doppler signal, size of 145x134mm, was thought to
be a pseudocyst which had pressed on nearby
organs (liver, stomach). It was a pancreatic pseudocyst but having a differential diagnosis of liver cyst.
MSCT examination:
MSCT showed a well-defined unilocular
pseudocyst in the pancreatic head and body, thin wall, size of 85x138mm.
Operation:
It was pancreatic pseudocyst, wall thickness of 7mm, filled yellowish fluid. Surgical drainage of the pseudocyst, which involves making a
connection between the cyst and the jejunum (Roux-en-Y
anastomosis).
Microscopic report:
Pancreatic pseudocyst.
Discussion:
Pancreatic pseudocyst caused rarely by
trauma and frequently happens in children. This case was a large pancreatic
pseudocyst in adult due to trauma. Ultrasound
was confused with a liver
cyst and priority of was MSCT higher
than. In this case, surgery asked for fluid analysis but forgetting of
counting amylase enzyme in withdrawn fluid, but we had microscopic report
of specimen to confirm a pancreatic pseudocyst.
References
Dapo Popoola, Mary Ann Lou, and Edward H. Sims. Traumatic Pancreatic Pseudocysts .J Natl Med Assoc. 1983 May; 75(5): 515–517.
Griffith, Antonio, Wong, Lee Chu, Levine, Ho, Paunipagar. Expertddx
ultrasound. Amirsys. 2010. Section 5:2-3.
Hassan A El Musharaf, Mohamed
A Al Auriefi. Traumatic pancreatic
pseudocyst. The Saudi Lewis G, Krige
JE, Bornman PC, Terblanche J. Traumatic pancreatic pseudocysts. Br J Surg. 1993
Jan; 80(1):89-93.
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