Right intrahepatic pseudocyst following acute pancreatitis: an unusual location after acute pancreatitis.
The location of a pseudocyst (PC) in the liver is an exceptional event, and intrahepatic PCs are mainly located in the left lobe. We report here a case of right intrahepatic PC following acute pancreatitis associated with cystic (aberrant pancreatic) dystrophy of the duodenal wall (CDDW) and chronic pancreatitis. Morphological assessment (ultrasound, computed tomography [CT] scan, and cholangio-magnetic resonance imaging [MRI]) revealed a 10-cm right intrahepatic collection and rupture of the main pancreatic duct. Percutaneous puncture permitted us to detect a high level of amylase in the collection, confirming the diagnosis of intrahepatic PC. Surgical drainage concomitant with pancreatico-duodenectomy for the treatment of CDDW resulted in disappearance of the collection. The mechanism involved in this patient was rupture of the pancreatic duct in the retroperitoneal cavity and erosion reaching the right hepatic parenchyma. Although intrahepatic PCs are rare, the diagnosis of intrahepatic PC complicating acute pancreatitis can be confirmed by a high level of amylase in the collection. Asymptomatic intrahepatic PCs can be treated conservatively, and symptomatic intrahepatic PCs can be managed either transcutaneously or surgically.
Balzan
Silvio
S
Department of Hepato-Pancreatico-Biliary Surgery, Hospital Beaujon, 92110, Clichy, France.
Kianmanesh
Reza
R
Farges
Olivier
O
Sauvanet
Alain
A
O'toole
Dermot
D
Levy
Philippe
P
Ruszniewski
Philippe
P
Ogata
Satoshi
S
Belghiti
Jacques
J
D000208:Acute Disease; D003560:Cysts / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D012422:Rupture, Spontaneous