Endoscopic treatment in a patient with obstructive jaundice caused by pancreatic pseudocyst

We report a case of chronic alcoholic pancreatitis with obstructive jaundice due to compression of the common bile duct by pancreatic pseudocyst. Ultrasonography and computed tomographic scan on admission demonstrated an 8 cm cystic lesion located at the head of the pancreas. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a segment of narrowing at the distal common bile duct which was compressed by the pancreatic pseudocyst. Communication between the cyst and pancreatic duct was also noted. Bacteriological examination of cystic contents yielded the growth of Proteus vulgaris, Morganella morganii, Stenotrophomonas maltophilia and Pseudomonas aeruginosa. The patient was treated with broad-spectrum antibiotic, endoscopic sphincterotomy, endoscopic nasopancreatic duct drainage, and transpapillary pancreatic endoprosthesis. Jaundice subsided gradually during admission and a marked reduction of pancreatic pseudocyst was found 18 months after discharge.