P0585 - Endoscopic Management of Infected Pancreatic Pseudocyst Arising in Patient With Distal Pancreatectomy After Retention of a 14-Year-Old Stent

We present a case of a patient with history of distal pancreatectomy 14 years prior who presented with an infected pancreatic pseudocyst due to pancreatic stent occlusion.

Case Description/

Methods:

An 80-year-old female with history of mucinous cystic neoplasm of the pancreas who underwent distal pancreatectomy and splenectomy 14 years ago that was complicated by post-operative pancreatic abscess presented to our center for new onset abdominal pain, intractable nausea with non-bloody emesis, weight loss, anorexia, and failure to thrive. Of note, her post-operative complications were managed with ERCP and pancreatic duct (PD) stenting complicated by migration of the stent into the PD requiring repeat ERCP for stent remove and replacement; multiple exploratory laparotomies and washouts; surgical necrosectomy; and temporary colostomy due to surgical colonic injury (eventually reversed 6 months after her initial surgery). She did well for 14 years, until she developed the new abdominal symptoms.

Computed tomography (CT) scan was performed demonstrating a 9.8 cm thick-rimmed collection at the surgical margin of the pancreas as well as a retained PD stent.

The decision was made to pursue endoscopic PD stent removal and EUS-cystgastrostomy for drainage of the infected pseudocyst (likely from PD stent occlusion). ERCP was performed with difficult extraction of the inwardly migrated PD stent, and successful cystgastrostomy was performed using a 15 mm by 10 mm lumen-apposing metal stent with immediate drainage of a copious amount of pus. The patient did well post-procedurally.

Discussion:

Minimally invasive endoscopic approaches are feasible strategies for managing adverse events related to PD stents.


Figure: Figure 1: CT Scan showing large pseudocyst and retained PD stent.


Figure: Figure 2: LAMS cystgastrostomy with immediate purulent drainage.

Disclosures:
Edward Villa: Olympus Corporation – Consultant.

Edward C. Villa, MD. P0585 - Endoscopic Management of Infected Pancreatic Pseudocyst Arising in Patient With Distal Pancreatectomy After Retention of a 14-Year-Old Stent, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.