An Unusual Case of Spontaneous Communication between Pancreatic Pseudocyst and Duodenum - A Case Report

Pancreatic pseudocysts are encountered frequently, but spontaneous communication is seen in less than 3 % cases. Perforation into peritoneal cavity, gastrointestinal tract, portal vein, pleural cavity has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with haemorrhage. In such cases emergency surgical intervention is the mainstay of management. Uncomplicated rupture of pseudocyst has not been reported frequently and is a rare presentation. We present an unusual case of pancreatic pseudocyst with duodenal connection without bleeding. A 45 year old male with a large pancreatic pseudocyst resulting from a complication of necrotizing pancreatitis came to our hospital with generalised weakness and exertional breathlessness since 1 week. Computed tomography (CT) revealed pancreatic pseudocyst and communication between pseudocyst and duodenum suggestive of spontaneous cysto duodenal fistula. Esophagogastroduodenoscopy (EGD) showed a fistula between pancreatic pseudocyst and duodenum, and the patient recovered without any complication or need for surgical treatment. Patient was managed conservatively