Repeated percutaneous aspiration therapy prior to surgery for a pancreatic pseudocyst: report of a case

We describe herein the case of a patient with a giant pancreatic pseudocyst which was first treated with repeated percutaneous aspiration therapy, then cured surgically by a Roux-en Y cystojejunostomy, 26 weeks after its formation. A 41-year-old man developed alcohol-induced acute severe pancreatitis. Computed tomography (CT) performed 10 weeks after the onset revealed a giant cyst, 20 x 18 x 7cm in size, arising from the body and tail of the pancreas and extending to the left loin. Endoscopic retrograde pancreatography (ERP) showed a normal main pancreatic duct without communication to the pseudocyst. As the asymptomatic pseudocyst, the wall of which was less than 2mm thick, had not resolved by 8 weeks after its formation, percutaneous aspiration therapy was performed three times. The patient was treated as an outpatient without any complications. The cyst wall was subsequently confirmed to be mature enough for surgical management to be initiated, and a cystojejunostomy was safely performed. Thus, percutaneous aspiration therapy can enable the surgeon to observe maturation of the cyst wall for a long period in patients with a pancreatic pseudocyst.