Diagnostic and Therapeutic Endoscopy 
Volume 4 (1998), Issue 3, Pages 155-160
doi:10.1155/DTE.4.155
Case Report

Endoscopic Fenestration of Pseudo Cyst in Acute Pancreatitis

Fuminori Yamagishi,1 Mistuyosi Shimoda,1 Takashi Sakamoto,1 Kastunori Tauchi,1 Kastuo Shimada,1 Takeichi Goka,1 Tadashi Bandou,1 Masao Fujimaki,1 and Ademar Yamanaka1,2

 1The Second Department of Surgery, Toyama Medical and Pharmaceutical University School of Medicine, 2630 Sugitani, Toyama 930-01, Japan
2Gastrocentor, Campinas University, Campinas, Brazil
Received 12 February 1997; Accepted 29 September 1997

Abstract

We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the stomach and there was no vessels between them. Endoscopic fenestration of the bulge was created using papillotome and diathermic snare. The drainage was effective and cyst was decompressed rapidly. The fenestration was closed after the cyst was diminished. Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter have been reported, however, these treatments sometimes resulted in infection and relapse because of the quick closure of the fistula. When the bulge is large and endoscopic ultrasonogram revealed low bleeding risk, the fenestration may be advisable for effective drainage of longer duration without infection.