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Acute pancreatitis presenting as a perinephric pseudocyst

Tanmaya Goel MS, MCh
Division of Urology, Kasturba Medical College (KMC), Manipal, India. Physical Address

K. Natarajan MS, FRCS (EDIN), FRCS (IRE), DNB, MCh
Division of Urology, Kasturba Medical College (KMC), Manipal, India. Physical Address

Arun Chawla MS, DNB, MCh, DNB
Division of Urology, Kasturba Medical College (KMC), Manipal, India. Physical Address

K. Sasidharan MS, MCH
Division of Urology, Kasturba Medical College (KMC), Manipal, India. Physical Address

Citation: T. Goel, K. Natarajan, A. Chawla & K. Sasidharan : Acute pancreatitis presenting as a perinephric pseudocyst. The Internet Journal of Surgery. 2009 Volume 20 Number 2

Keywords: Acute pancreatitis | pseudocyst | perinephric collection

 

Abstract

Acute pancreatitis presenting as a pseudocyst is well known. The sites of the pseudocyst are usually within the confines of the lesser sac. Herein we report a case of acute pancreatitis presenting principally as a perinephric pseudocyst.A perinephric pseudocyst is rare and can lead to diagnostic problems and its presence warrants exoneration of acute pancreatitis.


Case Report

A 46-year-old alcoholic male presented with severe, recurrent epigastric pain of three months’ duration. He subsequently developed left flank pain which lasted for a week. There were no other urological symptoms. Palpation disclosed tenderness in the epigastrium and left renal angle.

The patient’s investigations revealed moderately elevated serum amylase and lipase levels. USG of the abdomen showed a 9x7cm cystic collection surrounding the left kidney. This was further characterized and confirmed by a contrast enhanced CT of the abdomen; which also revealed a bulky pancreas (Figures 1, 2).

Thumbnail: Figure 1: CT scan shows a bulky pancreas with a perinephric collection
Figure 1: CT scan shows a bulky pancreas with a perinephric collection

Thumbnail: Figure 2: Contrast CT scan shows a non-enhancing perinephric collection
Figure 2: Contrast CT scan shows a non-enhancing perinephric collection

Ultrasonography(USG)-guided percutaneous aspiration of the cyst under antibiotic cover yielded 450ml of hemorrhagic fluid. The amylase and lipase levels of the aspirated fluid were 32,420 and 30,680 Units per liter, respectively. Percutaneous drainage of the collection was established along with supportive care. The patient recovered within a week. He was kept on regular follow-up and a review USG of the abdomen three months later revealed no reaccumulation.

Discussion

Acute pancreatitis presenting with a pseudocyst is very well known. The site of the pseudocyst varies depending on its origin from the head, body or tail of the pancreas, all usually within the confines of the lesser sac. A perinephric pseudocyst as an isolated event in acute pancreatitis is not a commonly described entity.

Only a few similar case reports are found in the literature(1,2,3). This case report highlights a rare possibility of pancreatic pseudocyst outside the traditional confines of the lesser sac.

Correspondence to

Dr. Tanmaya Goel
Division of Urology
Kasturba Medical College, Manipal, India.

E.mail: tanmaya.goel@yahoo.com

References

1. Mourad FH, Hannoush HM, Bahlawan M, Uthman I, Uthman S. Panniculitis and arthritis as the presenting manifestation of chronic pancreatitis. J Clin Gastroenterol. 2001; 32: 259-61 (s)

2. Curran AJ, Davidson IR, Keeling P, Corcoran M. Perinephric abscess as a presentation of pancreatitis. Br J Urol 1993; 71: 97-8. (s)

3. Mortelé KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Renal and perirenal space involvement in acute pancreatitis: spiral CT findings. Abdom Imaging 2000; 25: 272-8. (s)

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