A 47-year-old male with a history of smoking and alcoholism was admitted for acute abdominal pain and a diagnosis of pancreatic pseudocyst on alcoholic chronic pancreatitis.
Normal amylasemia.
After symptomatic treatment, the patient developed progressive dyspnea and right pleural effusion, which improved after pleural drainage.
A magnetic resonance cholangiography confirms the diagnosis and reveals an increase in the volume of the pseudocyst with probable communication point between pancreatic duct and pseudocyst.
Subsequently, the patient presents increased abdominal pain and worsening of his dyspnea as a result of the rupture of the pseudocyst and dissemination to the left pleural cavity through esophageal hiatus.
Pleural drainage was performed, finding pleural fluid with hemorrhagic characteristics compatible with pancreatic-pleural communication.
After initial improvement, the patient developed a progression of dyspnea and recurrence of the effusion, with a third pleural drainage and pleurodesis.
After improvement of the clinical picture was decided definitive surgical treatment of the pseudocyst.
1.
Twenty five days after admission the patient underwent surgery, performing a cystogastrostomy on the posterior gastric side with definitive improvement and reduction of the pseudocyst.
