Korean J Gastroenterol.  2017 Oct;70(4):202-207. 10.4166/kjg.2017.70.4.202.

Intrahepatic Pancreatic Pseudocyst Complicated by Pancreatitis: A Case Report

• Kim HJ
• Jun CH
• Park CH
• Cho CK

• KMID: 2392917
• DOI: http://doi.org/10.4166/kjg.2017.70.4.202

Abstract

Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11×10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.

Keyword

Pancreatitis; Intrahepatic pseudocyst; Hepatectomy

MeSH Terms

Abdominal Pain
Aged
Amylases
Endoscopy
Female
Hepatectomy
Humans
Liver
Pancreas
Pancreatic Pseudocyst*
Pancreatitis*
Peritoneal Cavity
Peritonitis
Amylases

Figure

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  Fig. 1 (A, B) Abdominal computed tomography scan revealed a huge cystic lesion in the lesser sac (white arrow). The appearance of the pancreas was normal (yellow arrow).

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  Fig. 2 (A) Follow-up abdominal computed tomography scan demonstrated a huge cystic mass arising from left lateral section of the liver. (B) Porto-mesenteric junction collapsed by the mass effect of cystic tumor (yellow arrows). The border between the pancreas and cystic mass was clearly demarcated (yellow arrow heads). Soft tissue stranded around the duodenum was seen, suggesting groove pancreatitis (white arrows). (C) Prominent periportal edema in the umbilical fissure was observed (white arrows).

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  Fig. 3 (A) Endoscopic ultrasonography revealed a huge hypoechoic lesion with internal echogenicity without any solid components or mural nodes. (B) A 7-Fr bipigtailed plastic stent was deployed.

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  Fig. 4 (A) A huge cystic mass arising from the left lateral section of the liver was seen. (B) The falciform ligament and Glisson pedicle were swollen remarkably and filled with necrotic fatty tissues (arrows).

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  Fig. 5 (A) Gross features: an unilocular cyst containing a ragged inner surface and thick fibrous wall. (B) The cyst is devoid of an epithelial lining (H&E stain, ×40). (C) The lining of the cyst is composed of granulation tissue, inflammatory cells, and fibrous tissue (H&E stain, ×100). (D) Marked necrosis, fat necrosis, and acute inflammatory cells are observed in the falciform ligament (H&E stain, ×100).

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  Fig. 6 Abdominal computed tomography after 28 months of operation. There were no abnormal findings of the liver (A) and pancreas (B).

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