Erzurum

Abstract

We present a case in which a pancreatic pseudocyst dissected into the right inguinal region, thus masquerading as an incarcerated right inguinal hernia. Computed tomography (CT) confirmed the diagnosis of a pseudocyst, and the patient was treated successfully with percutaneous drainage. From the Department of Surgery, Western Reserve Care System (Division of Forum Health), Youngstown, Ohio; and Northeastern Ohio Universities College of Medicine, Rootstown. Reprint requests to Danny Chung, MD, Research Department, Western Reserve Care System, 500 Gypsy Lane, Youngstown, OH 44501. FIGURE 1. Computed tomography shows pseudocyst with pancreatic fluid dissection into right inguinal hernia. Erzurum et al • UNCOMMON PRESENTATION OF PANCREATIC PSEUDOCYST 221 222 February 2000 • SOUTHERN MEDICAL JOURNAL • Vol. 93, No. 2 having as high as a 90% cure rate reported in some series. -7 We believe percutaneous drainage of pancreatic pseudocysts presenting themselves as symptomatic groin masses can be an effective treatment method allowing avoidance of surgery. Alternatives to percutaneous drainage include surgical excision, marsupialization, or endoscopic drainage. However, percutaneous drainage is becoming an attractive option because of its minimally invasive nature and ease of performance. Up to 90% of pseudocysts treated with percutaneous drainage are successfully cured in this manner. Contraindications to percutaneous catheter drainage include the presence of pancreatic necrosis or a solid nondrainable pancreatic mass, lack of safe access route, active pseudocyst hemorrhage. The clinician must be aware that the patient with a history of chronic pancreatitis and groin mass may in fact have a pseudocyst that has dissected to the inguinal region, especially if associated with elevated serum amylase and lipase values. A CT scan may confirm the diagnosis in this setting, allowing possible treatment with percutaneous drainage rather than surgery.