Have a male patient, 53 y.o. with a biliary acute pancreatitis that started about one and a half month ago,relatively mild in its clinical manifestations,when USN was done,showed a gallbladder full with stones, a normal CBD and a notorious enlargment of the pancreas...LFT within normal ranges,high levels of amylase and lypase...seven days later,a CT scan was performed and showed important diffuse enlargment of the whole pancreas with a huge cyst growing near the body and tail that rejected forwardly the stomach.
We made the diagnosis of a pseudocyst and waited for about one month before checking again with CT scan that showed that the cyst had grew reaching some 8 x 9 cms in diameter.
Two weeks ago, through endoscopy, a transgastric punction was done and a 7F catheter installed into the cavity...Some 700 mls. of a pinky fluid was aspirated...Since then,the cath has continue to drain about 180 - 200 cc of the same fluid, rich in amylases,around 33.000 U...New CT scan shows reduction of the cavity in some 40 % of its previous volume...The pt has continue to present fever, leucocitosis but no septic condition...He is under enteral nutrition through a naso yeyunal tube advanced quite distal to the angle of Treitz.
We are expecting to do an ERCP to see if there's a wide communication with pancreatic ducts...Depending on that,do you think surgical approach should be consider?.
Any comments or suggestions?