doiSerbia

Minimally invasive approach for the treatment of pancreatic pseudcyst. Transgastric drainage - where we are now?

Perišić Nenad (Military Medical Academy, Clinic for Gastroenterology, Belgrade, Serbia)
Bezmarević Mihailo (Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia), mihailobezmarevic@gmail.com.
Doder Radoje (Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia + University of Defense, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Mirković Darko (Military Medical Academy, Clinic for Gastroenterology, Belgrade, Serbia + University of Defense, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)
Brčerević Irina (Military Medical Academy, Clinic for Gastroenterology, Belgrade, Serbia)
Petrović Stanko (Military Medical Academy, Clinic for Gastroenterology, Belgrade, Serbia)

Introduction. Minimally invasive approach for the treatment of acute pancreatitis (AP) and its complications has proven to reduce morbidity and mortality rate, length of hospitalization and costs of treatment, and improve quality of life of the patients. This approach for the AP has been implemented in developed countries, but in our region lags behind. In this case report we presented the successful endoscopic transgastric drainage of the large pancreatic pseudocyst (PPC) developed as a complication of AP. Case report. A 63-years old male patient was presented with nausea and vomiting as a consequence of the compressive effects of the PPC in the body and tail of the pancreas after episode of AP. On computed tomography (CT) scan, it was shown a cystic formation in the region of the pancreatic body and tail compressing stomach which was verified on upper endoscopy. Under fluoroscopy, using lateral duodenoscope, the biliary plastic prosthesis of 12 French and 8 cm of length was placed throughout posterior stomach wall into the PPC. The intervention was finished uneventfully, without complications. On CT scan performed 7 days after procedure, the reduction of the PPC size was significant and control CT scan one month after the procedure and removal of the prosthesis showed almost complete resolution of the PPC. Conclusion. Endoscopic transgastric drainage is safe and effective procedure for PPCs especially when the PPC has propulsion effects on stomach wall.

Keywords: pancreatitis, acute disease, pancreatic pseudocyst, minimally invasive surgical procedures, drainage, treatment outcome