Intrahepatic localization of pancreatic pseudocyst: a case report

The location of a pseudocyst in the liver is an exceptional event. We report here a case developing right and left intrahepatic pseudocyst following acute biliary pancreatitis. Ultrasound and computed tomography scan revealed a 13-cm right and two 4-cm left intrahepatic collections. Percutaneous puncture permitted us to detect a high level of amylase in the collection, confirming the diagnosis of intrahepatic pseudocyst. Percutaneous drainage resulted in 3000 mL of fluid discharge. The mechanism involved in this patient was rupture of the pancreatic pseudocyst in the retroperitoneal cavity and erosion reaching the right hepatic parenchyma retroperitoneally posterior to the hepatoduodenal ligament and the left hepatic parenchyma via the hepatogastric ligament. Besides, endoscopic sphincterotomy was performed with endoscopic retrograde cholangiopancreatography for cholangitis. After performing endoscopic sphincterotomy, the cysts in the left lobe resolved dramatically. Intrahepatic pseudocyst should be kept in mind when an intrahepatic collection is found in a patients with chronic or recent episode of acute pancreatitis. Computed tomography and high level of amylase in the collection plays an important role for diagnosing this complication. In case of abdominal pain and large intrahepatic pseudocyst, percutaneous drainage can be performed.