Mazzola Poli de Figueiredo Sergio, Shah Nikhil R, Person Joshua
Department of Trauma & Acute Care Surgery, University of Texas Medical Branch Hospital, 301 University Blvd, Galveston, TX, 77555, United States.
Department of Trauma & Acute Care Surgery, University of Texas Medical Branch Hospital, 301 University Blvd, Galveston, TX, 77555, United States.
Int J Surg Case Rep. 2021 Mar;80:105635. doi: 10.1016/j.ijscr.2021.02.021. Epub 2021 Feb 9.
Pancreatic pseudocysts (PP) are known sequelae of pancreatitis. In this case, we present a patient with a pancreatic pseudocyst extending to the left psoas muscle, initially masquerading as acute complicated diverticulitis.
A 43-year-old male with previous episode of pancreatitis presented with a one-week history of abdominal pain. Physical examination revealed left lower quadrant tenderness. A computed tomography (CT) showed a large intraperitoneal fluid collection extending to the left psoas muscle with segmental inflammation of the descending colon. The patient was managed medically with empiric antibiotic therapy for concern of complicated diverticulitis. Ultrasound-guided percutaneous drainage was performed and fluid analysis showed lipase >20,000 U/L. The patient was discharged home with the drain. At one month follow up a repeat CT showed resolution of the left psoas fluid collection. The drain was removed and the patient remained asymptomatic at two month follow-up.
Pancreatic pseudocysts are well-known complications of pancreatitis. In this case, we describe extension of a pseudocyst to the left psoas muscle. We identified twelve previously reported patients diagnosed with PP involving the psoas muscles. Our case is unique as there is no previously published case in which a pseudocyst masqueraded as complicated diverticulitis. In analysis of the literature, most patients were managed with percutaneous drainage. Only 50% had documented complete resolution on follow up; of those 75% had undergone percutaneous drainage.
Pancreatic pseudocysts that extend to the psoas muscle can mimic acute complicated diverticulitis upon presentation. These may be effectively managed with percutaneous drainage.
胰腺假性囊肿（PP）是胰腺炎已知的后遗症。在本病例中，我们报告了一名胰腺假性囊肿延伸至左腰大肌的患者，该囊肿最初被误诊为急性复杂性憩室炎。
一名有胰腺炎病史的43岁男性，出现腹痛一周。体格检查发现左下腹压痛。计算机断层扫描（CT）显示腹腔内有大量液体聚集，延伸至左腰大肌，降结肠有节段性炎症。由于担心复杂性憩室炎，对该患者进行了经验性抗生素治疗。在超声引导下进行了经皮引流，液体分析显示脂肪酶>20,000 U/L。患者带引流管出院。在一个月的随访中，重复CT显示左腰大肌处的液体聚集消失。引流管被拔除，在两个月的随访中患者仍无症状。
胰腺假性囊肿是胰腺炎众所周知的并发症。在本病例中，我们描述了一个假性囊肿延伸至左腰大肌的情况。我们发现了12例先前报道的被诊断为累及腰大肌的胰腺假性囊肿患者。我们的病例独特之处在于，之前没有发表过假性囊肿伪装成复杂性憩室炎的病例。在文献分析中，大多数患者接受了经皮引流治疗。只有50%的患者在随访中有记录显示完全消退；其中75%的患者接受了经皮引流。
延伸至腰大肌的胰腺假性囊肿在表现上可酷似急性复杂性憩室炎。这些囊肿可通过经皮引流有效治疗。
