title: Severe acute pancreatitis after EUS-FNA of a pancreatic cyst: a rare, but serious complication.
abstract: As a consequence of improved quality of abdominal imaging techniques in the last decades, discovery of pancreatic cystic lesions has become more common. The clinical significance of these lesions is often unclear and poses a diagnostic dilemma. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a subject of debate regarding its role in the diagnostic evaluation of pancreatic masses and cysts. Although risks associated with the procedure are low, consequences can be serious and even life-threatening. We report a case of a previously healthy 59-year-old woman who suffered severe acute pancreatitis after EUS-FNA of a pancreatic cyst, requiring admission to the intensive care unit (ICU). Development of infected pancreatic necrosis and, successively, bowel ischaemia, led to multiple organ failure. Despite maximal antibiotic and surgical treatment the patient succumbed to refractory septic shock. The fatal outcome of this case illustrates the importance of balanced decision-making in the diagnostic approach of pancreatic cystic lesions.
authors.affiliation: Department of Intensive Care, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Els F
authors.initials: EF
authors.lastname: Jonkman
authors.affiliation: Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Bas A C
authors.initials: BA
authors.lastname: van Tuyl
authors.affiliation: Department of Radiology, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Floris B M
authors.initials: FB
authors.lastname: Sanders
authors.affiliation: Department of Intensive Care, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Lenneke E M
authors.initials: LE
authors.lastname: Haas
mesh_terms: D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000473:pathology; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology*