Year: 2026 | Month: May | Volume: 13 | Issue: 5 | Pages: 636-641
DOI: https://doi.org/10.52403/ijrr.20260560
Pancreatic Pseudocyst Masquerading as Gastric Outlet Obstruction with Pancreaticopleural Fistula: A Case Report
Dr. K N Vijay Kumar1, Dr. Manjunath H R2, Dr. Lakshmi Narayan3, Dr. Anil U S4, Dr. Ruchitha R Ligade5
1,5Post Graduate Resident, Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre (SIMSRC), Chikkabanavara, Bangalore – 560 090, Karnataka, India
2,3Professor, Department of General Surgery, SIMSRC, Bangalore – 560 090, Karnataka, India
4Senior Resident, Department of General Surgery, SIMSRC, Bangalore – 560 090, Karnataka, India
Corresponding Author: Dr. K N Vijay Kumar
ABSTRACT
Pancreatic pseudocysts are localised fluid collections arising as a complication of acute or chronic pancreatitis. While most pseudocysts are asymptomatic or present with nonspecific abdominal discomfort, large pseudocysts situated in proximity to the head or body of the pancreas may exert extrinsic compression on adjacent hollow viscera, producing clinically significant obstruction. Gastric outlet obstruction (GOO) as a manifestation of pancreatic pseudocyst is distinctly uncommon and constitutes a well-recognised diagnostic pitfall. We describe a 24-year-old male who presented with a 20-day history of progressive upper abdominal pain, distension, non-bilious vomiting, and new-onset breathlessness. Clinical and radiological evaluation revealed a large pancreatic pseudocyst compressing the first part of the duodenum and an associated left-sided pancreaticopleural fistula with pleural effusion. The patient was successfully managed with endoscopic ultrasound (EUS)-guided cystogastrostomy using a lumen-apposing metal stent (LAMS) with downstream pancreatic duct (DPD) stenting, along with intercostal chest drainage (ICD) for the pleural effusion. Complete resolution of both the obstruction and the pleural effusion was achieved. This case underscores the importance of considering pancreatic pathology in the differential diagnosis of gastric outlet obstruction, particularly in young patients without an obvious aetiology.
Keywords: Pancreatic pseudocyst; gastric outlet obstruction; pancreaticopleural fistula; EUS-guided cystogastrostomy; lumen-apposing metal stent; LAMS
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