A Rare Case Of Prehepatic Pseudocyst Of Pancreas In A Tertiary Care Center Of A Rural District Of Central India.

Abstract

Introduction:
Pancreatic pseudocyst is localized collection of pancreatic enzymes that are enclosed by a nonepithelial
wall. These cysts typically develop after pancreatitis or pancreatic ductal disruption. While
peripancreatic pseudocysts are relatively common the prehepatic location is exceptionally rare. Such
cysts occur when pancreatic secretions track through the hepato-gastric or hepato-duodenal ligaments
and accumulate anterior to the liver. The importance of knowing this entity is that it may occasionally
mimic hepatic or subphrenic pathology. Accurate radiological diagnosis is essential for management
planning and differentiation from other cystic lesions.
Case Report:
A 35-year-old male presented with a one-month history of upper abdominal swelling and dull aching
pain without fever or jaundice. On examination, a firm, non-tender lump was palpable in the
epigastrium extending to the left hypochondrium. Contrast-enhanced CT revealed a large thick-walled
peripancreatic collection extending into the perihepatic, perisplenic and gastrosplenic regions. This
collection was compressing the posterior gastric wall and communicating with a dilated pancreatic
duct. CT findings suggested a prehepatic pseudocyst with features of chronic calcific pancreatitis and
splenic vein thrombosis. The patient underwent cystogastrostomy with evacuation of approximately
2.5 Litres of thick cystic fluid. Dense adhesions were noted between the cyst, peritoneum and left
hepatic lobe. Postoperative recovery was uneventful and the patient was discharged with an advice to
follow-up after 2 weeks.
Conclusion:
Prehepatic pseudocyst of the pancreas is an extremely uncommon entity. It poses a significant
diagnostic challenge because of its unusual site and resemblance to hepatic lesions. Imaging plays an
important role in diagnosis and surgical planning. This case underscores the importance of considering
atypical pseudocyst locations particularly in patients with chronic pancreatitis.