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ERCP-associated infected intrahepatic pancreatic pseudocyst
Natthapon Angsubhakorn1, Leo Laub1, Joseph C Keenan1
1Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 284, Minneapolis, MN, 55455, USA.
Idcases
|March 9, 2019
Summary
An infected hepatic subcapsular pseudocyst caused septic shock after ERCP. This rare complication highlights the need for vigilance in managing pancreatic fluid collections, even in unusual locations.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Disease
Background:
- Pancreatic pseudocysts are fluid collections linked to pancreatitis.
- Subcapsular pseudocysts are rare, with atypical locations presenting management challenges.
Purpose of the Study:
- To report a case of infected hepatic subcapsular pseudocyst causing septic shock.
- To discuss the atypical presentation and rare complication of ERCP.
Main Methods:
- A patient with chronic pancreatitis underwent ERCP.
- Developed hypotension and was diagnosed with a subcapsular fluid collection via CT scan.
- Underwent CT-guided percutaneous drainage; fluid analysis revealed infection.
Main Results:
- The patient presented with septic shock post-ERCP.
- CT revealed a previously undescribed hepatic subcapsular fluid collection.
- Drainage yielded infected fluid with multiple bacterial species, including ESBL E. coli.
Conclusions:
- Hepatic subcapsular pseudocysts are rare and can lead to severe sepsis.
- ERCP may predispose to bacterial seeding of pseudocysts.
- Management requires prompt drainage and targeted antibiotics.
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