A 26-year-old male, with no known personal or family history of morbid obesity, abdominal pain and distension associated with nausea, vomiting, and absence of evolution varicella presented gases of 5 days.
He had no fever.
On physical examination, the abdomen was distended, with diffuse sensitivity and no signs of peritoneal irritation.
Laboratory tests at admission showed a hematocrit of 46%, leukocytes: 10600/mm3, CRP: 0.5 mg/dl, amylasemia 131U/L (VN: 28-100L) and lipase 129 U/L.
A CT scan of the abdomen and pelvis showed significant gastric disfunction with heterogeneous content secondary to cystic lesion in the thickness of the gastric antrum wall of approximately 4 cm. No signs of gastric wall pneumatosis or perforation were observed.
In view of the findings, we proceeded to perform an endosonography that showed, at the level of the anterosuperior aspect of the antro-pyloric region, a sunken lesion of approximately 4 cm, with a retractable mucosa that
Endoscopic ultrasound showed a well-defined hypoechogenic wall lesion with low flow at color Doppler of 3.5 × 3.1 cm within the echo-layers of the gastric mucosa, compatible with pseudocyst.
The pseudocyst was then punctured with a 19-gauge needle (Access needle needle, C needle), under endosonographic vision, leaving the sero-heart fluid.
A cystogastrostomy with cystogastrostomy (C Medical) was performed and the lesion was weaned with papillotomotome and pulltype, draining abundant fluid sero cavity without content.
The result of the biochemical study of the pseudocyst fluid was high in lipase: 57,930 U/L and amylase: 1,971 U/L, which confirmed that it was a pancreatic heterotopic pancreatitis in an antral pancreatic tissue.
The patient improved his symptoms and was monitored 24 months after drainage with computerized tomography with oral contrast that showed adequate contrast to small intestine and residual failure of abdominal cavity after determining a pseudocyst. The patient had a gastric obstruction 6 cm later.
As symptoms reappeared, a Roux-en-Y subtotal gastrectomy was performed because the patient had four days of hospitalization and evolution without complications.
The histopathological study showed a cystic lesion, whose wall did not present lining and this was composed of fibrous tissue, collagen and inflammatory infiltrate predominantly lymphocytic.
In the periphery of the cyst, heterotopic pancreatic tissue was observed in the thickness of the gastric wall, formed by variable ducts and preserved structure assemblages.
