Diagnostic and therapeutic challenges of pancreatic pseudocyst rupture into the peritoneal cavity

Abstract

Introduction: We describe the case of a 23-year-old man with a history of necrotizing pancreatitis who presented with abdominal pain, jaundice, and vomiting. Endoscopic ultrasound demonstrated a pancreatic pseudocyst measuring 6.2 × 5 cm. Objective: To describe the clinical case of a young patient with a history of necrotizing pancreatitis who presented spontaneous rupture of a pancreatic pseudocyst with peritonitis and the details of the therapeutic conduct applied. Clinic case: An endoscopic drainage was attempted, evacuating up to 70 mL but without placement of a lumen-apposing stent. Subsequently, the patient developed abdominal distension and peritoneal signs suggestive of an acute abdomen, for which he underwent an exploratory laparotomy with pancreatic cystostomy and irrigation and external drainage. He required ICU support for intraoperative instability, experienced a favorable recovery, and was discharged to rehabilitation. Conclusions: The case illustrates the stepwise management of pancreatic collections and shows that in resource-limited settings or in the presence of peritonitis or hemorrhage, damage-control surgery remains an effective option. Diagnostic and therapeutic implications are discussed.