Pancreatojejunostomy for Intrahepatic Pseudocyst: A Unique Approach

Abstract

Intrahepatic pseudocyst of pancreas is a very rare entity and a significant diagnostic dilemma with less than 30 cases reported in the world literature. Demonstration of amylase rich fluid and a communication with pancreatic duct system establishes the diagnosis. There are no definite guidelines for the management. Here we describe a patient with alchohol related chronic pancreatitis with pseudocyst in head of pancreas developing intrahepatic dissection of pseudocyst resulting in a large intrahepatic multicystic lesion. The diagnosis was made by CT scan and Ultrasound guided aspiration of intrahepatic cyst contents showing amylase rich fluid. The patient had to be treated for both the pancreatic pain and intrahepatic pseudocyst. The patient underwent lateral pancreaticojejunostomy. The surgery resulted in resolution of intrahepatic pseudocyst by decompressing the main pancreatic duct and also resolved the pain of chronic pancreatitis.The lateral pancreato jejunostomy in this case is unique and not described before to treat intrahepatic pseudocyst.