Case Report

A 46-year-old alcoholic male presented with severe, recurrent epigastric pain of three months’ duration. He subsequently developed left flank pain which lasted for a week. There were no other urological symptoms. Palpation disclosed tenderness in the epigastrium and left renal angle.

The patient’s investigations revealed moderately elevated serum amylase and lipase levels. USG of the abdomen showed a 9x7cm cystic collection surrounding the left kidney. This was further characterized and confirmed by a contrast enhanced CT of the abdomen; which also revealed a bulky pancreas (Figures 1, 2).

Figure 1

Figure 1: CT scan shows a bulky pancreas with a perinephric collection

Figure 2

Figure 2: Contrast CT scan shows a non-enhancing perinephric collection

Ultrasonography(USG)-guided percutaneous aspiration of the cyst under antibiotic cover yielded 450ml of hemorrhagic fluid. The amylase and lipase levels of the aspirated fluid were 32,420 and 30,680 Units per liter, respectively. Percutaneous drainage of the collection was established along with supportive care. The patient recovered within a week. He was kept on regular follow-up and a review USG of the abdomen three months later revealed no reaccumulation.

Discussion

Acute pancreatitis presenting with a pseudocyst is very well known. The site of the pseudocyst varies depending on its origin from the head, body or tail of the pancreas, all usually within the confines of the lesser sac. A perinephric pseudocyst as an isolated event in acute pancreatitis is not a commonly described entity.

Only a few similar case reports are found in the literature(₁,₂,₃). This case report highlights a rare possibility of pancreatic pseudocyst outside the traditional confines of the lesser sac.