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DOI: 10.1055/s-2004-814385
Endoscopic Transhiatal Drainage of a Mediastinal Pancreatic Pseudocyst
W. Mohl, M. D.
Caritasklinik St. Theresia
Internal Medicine
Gastroenterology
Rheinstr. 2
66113 Saarbruecken
Germany
Fax: +49-681-4061090
eMail: w-mohl@caritasklinik.de
Publikationsverlauf
Publikationsdatum:
09. Mai 2006 (online)
Transgastric drainage of pancreatic pseudocysts guided by endoscopic ultrasound is now a standard procedure in experienced hands [1] [2]. Mediastinal pancreatic pseudocysts are relatively rare; they result from extension of pancreatic pseudocysts into the mediastinum [3] [4] [5]. Most patients are symptomatic with abdominal pain or dysphagia. In the cases reported in the literature, treatment was mostly surgical; there were some reports of minimally invasive transcutaneous or transpapillary procedures and of conservative approaches.
Our patient was admitted with a suspected diagnosis of achalasia. Endoscopic ultrasound (EUS) showed a typical mediastinal pseudocyst. This was confirmed by aspiration from the cyst of fluid which had an excessive amylase level. Cytological investigation of another, more cranial, mediastinal mass confirmed a small-cell lung cancer as an incidental additional finding. We decided to perform a transgastric transhiatal puncture of the cyst. After location by EUS, the walls of the stomach and cyst were cut with the needle-knife, using a large-bore endoscope. This resulted in the drainage of large amounts of fluid. Because of this and in view of the presence of the lung cancer, a pigtail catheter was not inserted. The dysphagia resolved immediately.
The patient presented 4 months later with recurrence of dysphagia. The cyst was punctured again as described above, and a guide wire was introduced under fluoroscopic guidance. After bougienage, a 7-Fr double-pigtail catheter was inserted over the wire (Fig. [1]). Large amounts of chocolate-like fluid emerged (Fig. [2]) and once again the dysphagia resolved immediately. The pigtail catheter was removed after 2 weeks and the cyst caused no further symptoms. The patient died from progressive cancer about 8 months later.
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 1 Radiological view showing a double-pigtail catheter connecting the mediastinal pseudocyst and the stomach. The transhiatal position can be clearly seen.
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 2 Endoscopic view showing the gastric end of the pigtail catheter and the chocolate-colored discharge.
This case shows that transhiatal drainage of mediastinal pseudocysts is a technically feasible, minimally invasive technique that may provide full symptomatic relief.
Endoscopy_UCTN_Code_TTT_1AS_2AC
#References
- 1 Lo S K, Rowe A. Endoscopic management of pancreatic pseudocysts. Gastroenterologist. 1997; 5 10-25
- 2 Giovannini M, Pesenti C, Rolland A-L. et al . Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope. Endoscopy. 2001; 33 473-477
- 3 Satz N, Largiader F, Vorburger C. et al . Mediastinal pancreatic pseudocysts: report of two cases and review of the literature. Schweiz Med Wochenschr. 1983; 113 1095-1100 [in German with English abstract]
- 4 Mallavarapu R, Habib T H, Elton E. et al . Resolution of mediastinal pancreatic pseudocysts with transpapillary stent placement. Gastrointest Endosc. 2001; 53 367-370
- 5 Olah A, Nagy A S, Racz I. et al . Cardiac tamponade as a complication of pseudocyst in chronic pancreatitis. Hepatogastroenterology. 2002; 49 564-566
W. Mohl, M. D.
Caritasklinik St. Theresia
Internal Medicine
Gastroenterology
Rheinstr. 2
66113 Saarbruecken
Germany
Fax: +49-681-4061090
eMail: w-mohl@caritasklinik.de
References
- 1 Lo S K, Rowe A. Endoscopic management of pancreatic pseudocysts. Gastroenterologist. 1997; 5 10-25
- 2 Giovannini M, Pesenti C, Rolland A-L. et al . Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope. Endoscopy. 2001; 33 473-477
- 3 Satz N, Largiader F, Vorburger C. et al . Mediastinal pancreatic pseudocysts: report of two cases and review of the literature. Schweiz Med Wochenschr. 1983; 113 1095-1100 [in German with English abstract]
- 4 Mallavarapu R, Habib T H, Elton E. et al . Resolution of mediastinal pancreatic pseudocysts with transpapillary stent placement. Gastrointest Endosc. 2001; 53 367-370
- 5 Olah A, Nagy A S, Racz I. et al . Cardiac tamponade as a complication of pseudocyst in chronic pancreatitis. Hepatogastroenterology. 2002; 49 564-566
W. Mohl, M. D.
Caritasklinik St. Theresia
Internal Medicine
Gastroenterology
Rheinstr. 2
66113 Saarbruecken
Germany
Fax: +49-681-4061090
eMail: w-mohl@caritasklinik.de
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 1 Radiological view showing a double-pigtail catheter connecting the mediastinal pseudocyst and the stomach. The transhiatal position can be clearly seen.
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 2 Endoscopic view showing the gastric end of the pigtail catheter and the chocolate-colored discharge.