A case of intraabdominal penetration of bleeding in a pancreatic retention cyst

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 72; no. 12; pp. 3140 - 3144
• Main Authors: SUEYOSHI, Koichiro, KAJIKAWA, Shoji, SHIMADA, Kou, MIHARA, Motohiro, YAZAWA, Kazuyuki, SHIROTA, Hiroshi
• Format: Journal Article
• Language: Japanese; English
• Published: Japan Surgical Association 2011
• Subjects: bleeding in a pancreas cyst; pylorus preserving pancreatoduodenectomy; retention cyst
• DOI: 10.3919/jjsa.72.3140
• ISSN: 1345-2843

A 47-year-old man who had been treated for diabetes mellitus, chronic hepatitis B, and hepatic cirrhosis was seen at another hospital because of upper abdominal pain. Bleeding in a pancreatic cyst was diagnosed and conservative therapy was started, but the bleeding could not be controlled. The patient was thus brought into our hospital. When he arrived at our hospital, he was in a pre-shock state and an abdominal CT scan showed large quantities of ascites and a monolocular cyst about 4 cm in diameter at the pancreas head. Intraabdominal penetration of bleeding in the pancreatic cyst was diagnosed. His general condition was extremely poor. We determined that conservative therapy could not save his life and performed emergency operation. The operation was very difficult due to severe adhesions caused by inflammation around the pancreas head, but eventually pylorus-preserving pancreatoduodenectomy (PPPD) was done. The patient's postoperative course was uneventful and he was discharged from our hospital on his feet on the 40th hospital day. The histopathological diagnosis was pancreatic retention cyst. Few cases of pancreatic retention cyst have been reported so far. We often hesitate to employ surgical therapy for the patients in poor general condition, but it is the only option for saving their lives if conservative therapies are ineffective. We have to consider the surgical therapy aggressively in such cases.