Post-liver Transplantation Pancreatic Pseudocyst without Pancreatitis

Pancreatic pseudocysts rarely complicate acute pancreatitis after liver transplantation. We describe a case of post-transplant pancreatic pseudocyst occurring in the absence of pancreatitis. A 53-year-old post-hepatitis C cirrhotic man with no history of pancreatic or biliary abnormalities underwent liver transplantation. However, at the time of surgery, a T-tube cholangiogram revealed a mild dilation of the native bile duct and, two months later, a large pancreatic pseudocyst was diagnosed and surgically resected. After two years, biochemical cholestasis developed and a liver biopsy showed biliary damage. ERCP revealed a stenosis of Vater's papilla, which was successfully treated by sphincterotomy. Pancreatic pseudocyst may arise as a complication of OLT in the absence of postoperative acute pancreatitis or a history of chronic pancreatitis. In our patient, it is suspected that ampullary dysfunction associated with ischemic pancreatic injury and bacterial infection played a role in generating both the early pancreatic pseudocyst and the late cholestasis.