Treatment of oversize and recurrent pancreatic pseudocyst after an episode of acute pancreatitis: a case report and review management

Pancreatic cysts are being diagnosed more frequently because of the increasing usage of multiple noninvasive imaging modalities. Moreover, pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders, especially in cases where their treatment will be required. The diagnosis of a PP needs imaging with ultrasonography, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). In most cases, pancreatic pseudocysts are asymptomatic and resolve spontaneously. [1-3] Asymptomatic PPs up to 6 cm in diameter can be safely observed and monitored with serial imaging.[1] If they evolve and increase in size, they become symptomatic through compression of the adjacent organs and need interven-tion.[1, 4-6] Their management demands the cooperation of surgeons, radiologists and gastroenterolo-gists. The treatment of PPs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. Thus, many studies have reported successful drainage through the use of various techniques.[1, 3, 4] However, the absence of a large number of cases as well as guidelines for dealing with them raise even today dilemmas regarding the treatment of choice. Here we present a case of a large pancreatic pseudocyst and a brief review of the literature.