55-Year-Old Male’s Abdominal Pain Diagnosed as Atypical Pancreatic Pseudocyst, Successfully Treated with Advanced Surgery

A 55-year-old male presented with persistent dragging pain in his left upper quadrant, which worsened after eating. Over the past three months, the patient had significantly reduced his food intake due to the pain, leading to noticeable weight loss. Initially, his symptoms were misdiagnosed as simple gastritis, and local treatment was administered. However, the patient’s condition did not improve, prompting further investigation.

A sonography revealed a peri-splenic hematoma, a collection of blood around the spleen, typically associated with blunt abdominal trauma. Despite the absence of a clear traumatic event, conservative management was employed based on initial CT findings, which also showed the hematoma. Unfortunately, these conservative measures did not alleviate the patient's symptoms.

Dr. Vinay Thati, a General Surgeon at Wockhardt Hospitals Mumbai Central, decided to reassess the patient’s condition due to the lack of progress. Recognizing the limitations of the initial imaging and treatment approach, Dr. Thati ordered a new CT scan from another center for a fresh perspective. This scan uncovered an unexpected finding: a pancreatic pseudocyst located above the spleen. This was atypical, as pancreatic pseudocysts typically form behind the pancreas, not above it.

The unusual location of the pseudocyst and the patient's persistent symptoms led to the decision to proceed with surgical intervention. Initially, the plan was to perform laparoscopic surgery to minimize invasiveness. However, due to the pseudocyst's challenging position, the procedure was converted to an open surgery. During the operation, the surgical team established an internal drainage system by anastomosing a part of the jejunum (small intestine) to the pseudocyst. This technique allowed pancreatic juices to drain effectively into the small intestine and facilitated the gradual collapse of the pseudocyst.

Dr. Thati commented, “Accurate diagnosis and tailored treatment are crucial when dealing with complex abdominal conditions. Identifying the pancreatic pseudocyst in this atypical location was essential for effectively addressing the patient's symptoms. By opting for internal drainage, we avoided the complications associated with external fistulas and achieved a successful outcome. It’s gratifying to see the patient’s positive recovery following the surgery.”

The case underscores the importance of thorough diagnostic evaluation in managing abdominal pain with ambiguous origins. The initial misdiagnosis as gastritis and the subsequent identification of an atypical peri-splenic hematoma and pancreatic pseudocyst highlight the need for vigilance and persistence in diagnosis. Following the surgery, the patient experienced a complete resolution of pain, improved appetite, and weight gain during a one-month follow-up.

Dr. Vinay Thati’s intervention, including advanced imaging and innovative surgical techniques, successfully addressed the patient’s condition and led to a positive recovery. This case illustrates the significance of precise diagnosis and appropriate surgical intervention in achieving optimal patient outcomes.

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