Intrahepatic Pancreatic Pseudocysts: A Review of Recent Literature and Case Report

Abstract

Background: Intrahepatic pancreatic pseudocysts (IHPP) are a rare clinical entity which results from migration of amylase rich proteolytic pancreatic fluid along hepatogastric or hepatoduodenal ligaments into the hepatic parenchyma. There are no current management guidelines, and definitive management depends on varying features within each individual case. We report a rare case presenting with features of acute gastric outlet obstruction on a background of chronic pancreatitis. The rapid formation of this IHPP does not appear to have been previously reported in the literature. Methods: We conducted a comprehensive literature search of both PubMed and the Cochrane library to identify cases of IHPPs in recent literature. This review article aims at comparing the clinical features and management of the reported case with those reported in world literature. Results: Diagnosis and clinical management of IHPP is challenging. A combination of CT scanning and aspirate sampling are the most useful in establishing a diagnosis. Clinical management includes a conservative approach, percutaneous/ endoscopic drainage, ERCP and pancreatic duct stenting. Open surgical management is reserved for cases where serious complications have occurred. Conclusion: This is the first documented rapid formation of an IHPP in current literature. The most common approach for the management of IHPPs is through radiologically guided percutaneous drainage. Early diagnosis and successful definitive management are probably best determined by the size of the lesion and severity of the clinical presentation.