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Erschienen in: Clinical Journal of Gastroenterology 4/2020

20.02.2020 | Case Report

Endoscopic ultrasonography-guided drainage for spontaneous rupture of a pancreatic pseudocyst into the peritoneal cavity in a patient with autoimmune pancreatitis

verfasst von: Kazuya Koizumi, Sakue Masuda, Tomohiko Tazawa, Makoto Kako, Shinichi Teshima

Erschienen in: Clinical Journal of Gastroenterology | Ausgabe 4/2020

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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.
Literatur
1.
Zurück zum Zitat 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.CrossRef 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.CrossRef
2.
Zurück zum Zitat 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.CrossRef 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.CrossRef
3.
Zurück zum Zitat Habashi S, Draganov PV (2009) Pancreatic pseudocyst. World J Gastroenterol 15:38–47 (Review) Habashi S, Draganov PV (2009) Pancreatic pseudocyst. World J Gastroenterol 15:38–47 (Review)
4.
Zurück zum Zitat Ang TL, Teoh AYB. Endoscopic ultrasonography-guided drainage of pancreatic fluid collections. Dig Endosc. 2017;29:463–71.CrossRef Ang TL, Teoh AYB. Endoscopic ultrasonography-guided drainage of pancreatic fluid collections. Dig Endosc. 2017;29:463–71.CrossRef
5.
Zurück zum Zitat 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.CrossRef 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.CrossRef
8.
Zurück zum Zitat Nishimura T, Masaoka T, Suzuki H, et al. Autoimmune pancreatitis with pseudocysts. J Gastroenterol. 2004;39:1005–100.CrossRef Nishimura T, Masaoka T, Suzuki H, et al. Autoimmune pancreatitis with pseudocysts. J Gastroenterol. 2004;39:1005–100.CrossRef
9.
Zurück zum Zitat 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.CrossRef 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.CrossRef
10.
Zurück zum Zitat 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.CrossRef 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.CrossRef
Metadaten
Titel
Endoscopic ultrasonography-guided drainage for spontaneous rupture of a pancreatic pseudocyst into the peritoneal cavity in a patient with autoimmune pancreatitis
verfasst von
Kazuya Koizumi
Sakue Masuda
Tomohiko Tazawa
Makoto Kako
Shinichi Teshima
Publikationsdatum
20.02.2020
Verlag
Springer Singapore
Erschienen in
Clinical Journal of Gastroenterology / Ausgabe 4/2020
Print ISSN: 1865-7257
Elektronische ISSN: 1865-7265
DOI
https://doi.org/10.1007/s12328-020-01104-9

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