Muhammad Afzal, Syed Ghulam Ghous, Khalid Siddiq.
Spontaneous rupture of Pancreatic Pseudocyst.
J Coll Physicians Surg Pak Jan ;14(6):370-1.

A 3 years old boy was admitted with complaints of pain abdomen and progressive abdominal distension for 04 months. Initially he had severe vomiting and diffuse abdominal pain. Vomiting settled in 4-5 days but dull pain persisted in whole abdomen, which later localized to the upper abdomen. For the last one month frequency of pain and abdominal distension increased. On examination he was pale, sick looking, febrile and weighed 13 kg. Abdomen was distended, especially a bulge was noted in left upper quadrant. There was moderate tenderness present all over the abdomen. Ultrasonography (USG) abdomen revealed a large cystic mass adjacent to left kidney extending posteriorly. Findings were consistent with large size left perinephric abscess. Other investigations revealed hemoglobin (Hb) 9.0 gm%, total leukocyte count (TLC) 15,800/mm, ESR 85 mm and serum urea 27 mg/dl. Based on these findings, US- guided aspiration was planned. Suddenly condition of child deteriorated. He became cyanosed with cold, clammy extremities and developed moderate difficulty in breathing. He was immediately shifted to intensive care unit when i/v fluids, oxygen inhalation and fresh whole blood was transfused. USG abdomen was repeated. It revealed massive ascites while size of cystic mass had reduced to about 20% of the size noted previously. Diagnostic aspiration of ascitic fluid was done. Fluid was hemorrhagic amylase level 15000 u/l. Repeat blood tests showed Hb 6.5 gm%, TLC 36.6x109/l, serum urea 7.1 mmol/l. Serum amylase 1800 u/l, blood sugar 6.3 mmol/l and serum calcium 2.2 mg%. Based on these findings, he was diagnosed as a case of pancreatic pseudocyst which ruptured spontaneously leading to shock. Continued …

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