Abstract
A 75-year-old man was referred to our hospital due to a huge pancreatic cyst. Computed tomography revealed a monocular cyst 15 cm in size without a solid mass lesion nearby. He was diagnosed with pancreatic pseudocyst. Endoscopic ultrasound (EUS)-guided drainage was planned for the next day due to abdominal distension; however, the pseudocyst ruptured into the peritoneal cavity before treatment could be applied. To prevent the progression of peritonitis, EUS-guided drainage of the pseudocyst was performed. A nasocystic tube and plastic stent were placed into the ruptured cyst via the gastric wall through the same puncture tract. After the treatment, the cyst rapidly decreased in size, and the peritonitis improved without surgery. The patient’s serum IgG4 level was found to be elevated to 820 mg/dL. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct stricture without obstruction. No communication between the main pancreatic duct and the pseudocyst was found. An EUS-guided fine-needle aspiration biopsy of the hypoechoic site was performed, revealing IgG4-positive plasma cell infiltration. He was finally diagnosed with AIP associated with the rupture of a pseudocyst. Oral corticosteroid (30 mg/day) treatment was started and gradually tapered. There has been no recurrence in the 28 months since the initiation of treatment.
Similar content being viewed by others
References
Donet JA, Barkin JA, Keihanian T, et al. Pancreatic pseudocysts and parenchymal necrosis in patients with autoimmune pancreatitis: a systematic review. Pancreas. 2018;47:952–7.
Yamamoto K, Itoi T, Sofuni A, et al. The role of endoscopic ultrasound-guided drainage for autoimmune pancreatitis-associated pancreatic cysts: a report of five cases and a literature review. Intern Med. 2018;57:1523–31.
Habashi S, Draganov PV (2009) Pancreatic pseudocyst. World J Gastroenterol 15:38–47 (Review)
Ang TL, Teoh AYB. Endoscopic ultrasonography-guided drainage of pancreatic fluid collections. Dig Endosc. 2017;29:463–71.
Kubota K, Fujita Y, Sato T, et al. Autoimmune pancreatitis associated with pancreatic cyst: how can we manage it? J Hepatobiliary Pancreat Sci. 2014;21:902–10.
Rocha R, Marinho R, Gomes A, Sousa M, Pignatelli N, Carneiro C, Nunes V. Spontaneous rupture of pancreatic pseudocyst: report of two cases. Case Rep Surg. 2016. https://doi.org/10.1155/2016/7056567.
Mujer MT, Rai MP, Atti V, et al. Spontaneous rupture of a pancreatic pseudocyst. BMJ Case Rep. 2018. https://doi.org/10.1136/bcr-2018-226296.
Nishimura T, Masaoka T, Suzuki H, et al. Autoimmune pancreatitis with pseudocysts. J Gastroenterol. 2004;39:1005–100.
Sohn JW, Cho CM, Jung MK, et al. A case of autoimmune pancreatitis manifested by a pseudocyst and IgG4-associated cholangitis. Gut Liver. 2012;6:132–5.
Matsubayashi H, Iwai T, Matsui T, et al. Pancreatic cystic lesions with atypical steroid response should be carefully managed in cases of autoimmune pancreatitis. J Gastroenterol Hepatol. 2016;31:270–6.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Human rights
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Koizumi, K., Masuda, S., Tazawa, T. et al. Endoscopic ultrasonography-guided drainage for spontaneous rupture of a pancreatic pseudocyst into the peritoneal cavity in a patient with autoimmune pancreatitis. Clin J Gastroenterol 13, 591–596 (2020). https://doi.org/10.1007/s12328-020-01104-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-020-01104-9