A 43-year-old woman with a history of smoking, cervical osteomyelitis requiring surgical treatment and tuberculosis treated during her youth were the most important.
In 2014, she was diagnosed with moderately differentiated adenocarcinoma of the colon (splenic angle), with pancreatic adipose tissue in the tail, which was treated by left hemicolectomy and resection of the tail after surgery
The patient presented a post-operative diagnosis of stenosis with suture fixation and development of a secondary pancreatic fistula requiring surgical re-intervention on several occasions until discharge.
After six months of outpatient follow-up, a fluid collection of 62 x 68 mm between the pancreatic tail and the spleen persisted, producing a feeling of fullness, postpandrial vomiting and pain in the left hypochondrium.
Given the oncological history of the patient, it was initially decided to perform an ultrasound-guided puncture-aspiration of the collection to rule out malignancy.
Endoscopy showed a rounded collection of 65 x 70 mm in the theoretical region of the body-coil of the pancreas, with content inside.
The biochemical and cytological analysis of the sample obtained from the collection was compatible with a pseudocyst and ruled out tumor recurrence rate 40.
Because of the absence of malignancy and the patient's condition, a collection drainage guided by ultrasound guided frontal puncture (FV-CLA; TGF-J) was performed in a second time.
At the subunit level, and through up-down rotation and elevation movements, a good ultrasound window was placed to visualize the collection between body and tail of the pancreas.
A transgastric puncture of the pseudocyst was performed with a 19 G needle (EzShot, Olympus Inc.) and aspiration confirmed the appropriate situation within the collection material.
Once the lesion was punctured, the usual drainage steps were followed (1).
Under fluoroscopic control, a 0.035 inch guidewire (Jagwire, Boston Scientific) was advanced, forming several loops inside the collection.
Afterwards, needle sphincterotomy (Boston Scientific) was performed by applying electrocautery with diathermy source.
Once the fistula was left in place between the stomach and the collection, a 6 mm balloon dilation (Boston Scientific) was performed to allow the introduction of a fully reopened 10 x 60 mm self-expanding metallic biliary stent
To prevent its migration and occlusion, another plastic double pigtail biliary stent and 7 Fr x 6 cm were telescoped. The procedure was uneventful and the patient was discharged 72 hours after the surgery at home.
