Pancreatic cystocholedochostomy. First report of a case.

The treatment of choice for most persistent, mature pseudocysts of the pancreas is internal drainage. Cystogastrostomy, cystojejunostomy with a Roux-en-Y loop, and, less frequently, cystoduodenostomy are the surgical techniques most commonly employed to attain effective internal drainage. We present the case of a patient with a pseudocyst arising from the cephalic portion of the pancreatic head and extending into the porta hepatis, causing obstructive jaundice, who was treated by cystocholedochostomy. This simple procedure was performed after an intraoperative cholangiogram showed no ductal obstruction distal to the pseudocyst. A cholecystectomy was also done, and the common bile duct was drained with a T tube. This expeditious procedure, rather than a Roux-en-Y cystojejunostomy, was elected because of the firm adherence of the posterior wall of the common bile duct to the anterior surface of the pseudocyst. The patient had an uncomplicated recovery and has been completely asymptomatic for 2 years. We believe this is the first report of a pancreatic cystocholedochostomy for a pancreatic pseudocyst.