Sodoma Andrej M, Bulba Nicholas, Pellegrini James R, Singh Jaspreet, Costantino Antonio
Internal Medicine, South Shore University Hospital, Bay Shore, USA.
Gastroenterology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA.
Cureus. 2024 Sep 30;16(9):e70534. doi: 10.7759/cureus.70534. eCollection 2024 Sep.
Pancreatic cysts are abnormal masses found in the pancreas. They are either cancerous or benign and are mostly found incidentally on imaging. The majority are asymptomatic, but these cysts can sometimes become so large that they obstruct the function of structures around them. In this case, a pancreatic pseudocyst became so large that it caused hydronephrosis. An elderly female presented to a community hospital with abdominal pain. A computed tomography (CT) during that admission noted intraductal papillary mucinous neoplasm with ductal dilatation worrisome for underlying malignancy. An MRI was recommended but could not be performed due to incompatible hardware. The patient's abdominal pain improved, so she was discharged for outpatient endoscopic ultrasound (EUS). Soon after discharge, the patient experienced worse right upper quadrant (RUQ) pain. A repeat CT upon her return to the hospital showed a new pancreatic pseudocyst causing left hydronephrosis. The patient was transferred to a tertiary care center for further management. An esophagogastroduodenoscopy (EGD) was performed, and an extensive peripancreatic fluid collection was identified, measuring approximately 11 cm × 7 cm. A 15 mm Hot AXIOS (LAMS) cystogastrostomy tube was placed, and the cytopathology report was negative for malignant cells. A repeat CT abdomen post-procedure showed near-complete resolution of pseudocyst. A repeat EGD was performed to monitor the cyst and remove the LAMS cystogastrostomy tube. The patient was discharged home with close follow-up with GI. Overall, pancreatic pseudocysts sometimes resolve, but if they do not, they require surgery. In this case, minimally invasive advanced endoscopy using a cystogastrostomy tube relieved the patient's obstruction.
胰腺囊肿是在胰腺中发现的异常肿块。它们要么是癌性的，要么是良性的，大多是在影像学检查时偶然发现的。大多数囊肿没有症状，但这些囊肿有时会变得很大，以至于阻碍周围结构的功能。在这个病例中，一个胰腺假性囊肿变得如此之大，以至于导致了肾积水。一名老年女性因腹痛到一家社区医院就诊。入院时的计算机断层扫描（CT）显示导管内乳头状黏液性肿瘤伴导管扩张，令人担忧潜在的恶性肿瘤。建议进行磁共振成像（MRI）检查，但由于硬件不兼容而无法进行。患者的腹痛有所改善，因此她出院接受门诊内镜超声检查（EUS）。出院后不久，患者右上腹（RUQ）疼痛加剧。她再次入院时的CT检查显示出现了一个新的胰腺假性囊肿，导致左肾积水。患者被转到一家三级医疗中心进行进一步治疗。进行了食管胃十二指肠镜检查（EGD），发现胰腺周围有大量液体聚集，大小约为11厘米×7厘米。放置了一根15毫米的热轴（LAMS）囊肿胃造瘘管，细胞病理学报告显示未发现恶性细胞。术后复查腹部CT显示假性囊肿几乎完全消退。再次进行EGD以监测囊肿并取出LAMS囊肿胃造瘘管。患者出院回家，由胃肠病学专家密切随访。总体而言，胰腺假性囊肿有时会自行消退，但如果不消退，则需要手术治疗。在这个病例中，使用囊肿胃造瘘管的微创高级内镜检查缓解了患者的梗阻。
