34 year old male smoker of 10 cigarettes per day and drinking more than 80 gr. ethanol/day. On December 9th he was admitted in his reference hospital for enolic acute pancreatitis corresponding to Balthazar stage C, being readmitted 4 months later for epigastric pain secondary to pseudocyst in the head-uncinate process of the pancreas, of 6 cm, which caused a slight stasis of the intrapancreatic bile duct . The following month, he was admitted again for episodes of significant abdominal pain not eased with intravenous analgesia, requiring morphine derivatives to control it. He also showed postprandial fullness and weight loss. The patient underwent a CT scan showing increased pseudocyst (7.5 cm x 8.5 cm), which caused more mass effect on adjacent structures, as well as ectasia of the bile duct. He was then referred to our hospital for the drainage of the pseudocyst to the gastric cavity by endoscopic ultrasonography.
The patient underwent an EUS, showing a 9-cm cystic lesion in the pancreatic head, from which a yellowish fluid was extracted (biochemical testing consistent with pseudocyst).
We proceeded to the placement of a pigtail prosthesis, failing in its insertion, deciding then the placement of a 8.5F straight type prosthesis. After examination, the patient developed sudden severe abdominal pain, so that he underwent an urgent CT scan shown in figures 1 and 2.