One of the Largest Pancreatic Pseudocysts in the Literature: A Case Report

The pancreatic pseudocyst is a pancreatic fluid collection which classically develops due to acute or chronic pancreatitis. A 68-year-old male with the remote history of alcohol abuse presented with abdominal pain secondary to acute pancreatitis. The first computed tomography (CT) of the abdomen showed acute necrotizing pancreatitis. He was initially treated conservatively. Repeat CT of the abdomen after two weeks revealed a peripancreatic fluid collection of 20x12x10 cm. One month later, he became septic following biliary stent placement. Repeat CT of the abdomen showed an enlarging pseudocyst of 25x20x14 cm (estimated 7000 mL of fluid). Percutaneous CT-guided cyst drainage was performed and only three liters of infected fluid could be drained which eventually grew Enterococcus faecalis. Due to lack of improvement, he underwent laparotomy with pancreatic necrosectomy, pseudocyst debridement, and cholecystectomy. The patient did well postoperatively and until one-year follow-up visit. The largest pancreatic pseudocyst in the literature (about 9500 mL) was reported in 1882. To our knowledge, this case is the second largest pseudocyst in the literature which was successfully managed by surgical resection.