Case Report
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World J Gastrointest Endosc. Sep 16, 2013; 5(9): 461-464
Published online Sep 16, 2013. doi: 10.4253/wjge.v5.i9.461
Uncomplicated spontaneous rupture of pancreatic pseudocyst into stomach: A case report
Piyush O Somani, Samit S Jain, Dharmesh K Shah, Amol A Khot, Pravin M Rathi
Piyush O Somani, Samit S Jain, Dharmesh K Shah, Amol A Khot, Pravin M Rathi, Department of Gastroenterology, Topiwala National Medical College, Bai Yamunabai Laxman Nair Hospital, Mumbai 400008, India
Author contributions: Somani PO designed the report and wrote paper; Somani PO, Khot AA and Rathi PM were attending doctors for the patient; Jain SS and Shah DK organized the report.
Correspondence to: Pravin M Rathi, Professor, Head, Department of Gastroenterology, Topiwala National Medical College, Bai Yamunabai Laxman Nair Hospital, Dr A L Nair Road, Mumbai Central, Mumbai 400008, Maharashtra, India. rathipmpp@gmail.com
Telephone: +91-22-23016139 Fax: +91-22-23021168
Received: May 22, 2013
Revised: July 22, 2013
Accepted: August 12, 2013
Published online: September 16, 2013
Processing time: 128 Days and 17.2 Hours
Abstract

Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography (CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric fistula.The fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.

Keywords: Chronic pancreatitis; Cystogastric fistula; Fistula; Pancreas; Pancreatitis; Pseudocyst

Core tip: Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. Only few cases had been reported in literature till date. We managed the case conservatively without surgical intervention.