This is a case presentation of pancreatic pseudocyst

1. Pancreatic pseudocyst
Dr Arjun Raja A
RIMS, Imphal

2. Particulars of the patient
• Name : DK
• Age 59
• Sex male
• Occupation -carpenter
• Religion- Hindu
• Address- Kangpokpi Distric
• DOA - 1/6/18
• DOE - 3/6/18

3. Chief complaints
• Pain in the upper part of abdomen 3 months
• Swelling in the upper part of abdomen 2 1/2 months

4. History of presenting illness
Patient was apparently well 3 months back when patient got
abdominal pain which was sudden in onset and colicky in
nature,pain started in central part of abdomen and was radiating to
back, pain got aggravated with intake of food and got relieved with
medications, pain increased in intensity for first two days and
subsided with treatment within six days.

5. Contd/ history of presenting illness
• Abdominal pain was associated with multiple episodes of bilious
vomiting containing food particles later fluids.
• 15 days later he noticed a swelling in the central part of abdomen
which was gradually increasing in size for the first two months, for the
last 15 days size of swelling is static. Swelling was associated with dull
aching pain over the swelling, and it was not associated with fever
and skin changes over the swelling
• No history of trauma,yellow discolouration of eyes and urine.

6. Contd
• No history of chest pain, cough, breathlessness ,palpitation,
• No history of swelling of face or feet
• No history of headache, loss of consciousness, convulsions
• No history of weight loss

7. Past history
• No history of similar illness in the past.
• No history of any operations in the past.
• History of hypertension for six years, not on regular medication
• No history of TB,TB contact,Type 2 diabetes
• No history of heart disease

8. Personal & family history
• Patient is married 3 children( 19,12 &7yrs,) ,non vegetarian
• A chronic alcoholic (300-400ml daily for 10years)
• A chronic smoker ( 5-6 cigarettes per day for 13 years)
• Bowel and bladder habits are normal
• Middle class family
• Both parents died( father - heart attack 10 years ago & mother stroke)
• Patient has 3 siblings, two male and one female,All are healthy
• Elder brother is also a chronic alcoholic

9. Treatment history
• Patient is Hypertensive on irregular medication
• History of Ayurvedic drugs medication
Allergy history
• No history of any allergy to drugs or food noted

10. Physical examination (general survey)
• Patient is conscious, alert, cooperative
• Moderately build and nourished
• Weight-65kg,height-163cm,BMI -24.4
• Mild pallor and mild icterus present
• No jaundice, no clubbing ,no edema ,
• No raised JVP, no cervical lymphnode enlargement

11. contd /General Survey
• Pulse 88/min,regular
• BP 150 /90 mm Hg,(Rt)
• Respiration 26/min
• Temperature 98.2 F

12. Local(abdominal) examination
Inspection
• Slight fullness in epigastric and umbilical region
• Umbilicus -central&inverted
• All quadrants move equally with respiration
• No pigmentation, or noVenus Engorgement, skin is normal
• Hernial sites and external genitalia are normal

13. Palpation(abdomen)
Superficial palpation
• No local rise of temperature
• No local tenderness
• No muscle guarding
• A swelling palpable in epigastric, left hypochondrium and umbilical area which is globular
are in shape, size of 15 cm horizontal and 10cm vertical, tense and cystic in consistency,
non-tender, with rounded margins and smooth surface, with indistinct lower margin and
couldn’t get above the swelling , with no movement with respiration and no intrinsic
mobility.
• The plane of swelling is intra abdominal and retroperitoneal

14. contd palpation(abdomen)
Deep palpation
• No tenderness on Deep palpation
• No hepatosplenomegaly
• No evidence of kidney enlargement
• No fluid thrill

15. Percussion
• Generally resonant note all over the abdomen and over the swelling.
• No shifting dullness.
• Upper border of liver felt at sixth intercostal space.
• No dullness in renal angle area.

16. Auscultation
• Normal bowel sounds heard.
• No bruits or added sounds

17. Systemic examinations
• Respiratory system.
• Cardiovascular system.
• Central nervous system.

18. Summary
• A 59-year-old gentleman presented with history of acute pain in
abdomen for three months duration, which was sudden in onset,
colicky in nature and started in central part of abdomen and radiating
to back, Pain was increasing in increasing for two days and subsided
with treatment in six days. Patient had history of nausea and vomiting
associated with pain. After 15 days following onset of pain patient
noticed a small swelling in central part of upper abdomen,which was
gradually increasing in size for the last two months, for last 15 days
size of swelling has become static, and was associated with dull
aching pain over swelling.

19. Contd
• Patient is chronic alcoholic for 10 years and chronic smoker for 13
years. Patient has history of hypertension for six years and is on
irregular medications. No history of trauma, jaundice, recurrent
abdominal pain. Bowel and bladder habits are normal. No other
systemic compliants.
• On general examination there is mild icterus and pallor,on abdominal
inspection there is slight fullness in epigastric and umbilical
region,skin about the swelling is normal.

20. Contd
• On palpation a lump is palpable in epigastrium extending into left
hypochondrium and umbilical region which is cystic in consistency
and non-tender with the size of 15cm* 10cm and globular in shape,
margins are rounded,surface is smooth ,lower border is
indistinct,can’t get above swelling and not moving with respiration
and with no intrinsic mobility. Mass is resonant to percussion. Plane
of swelling is intra-abdominal and retroperitoneal. Rest of abdomen is
normal. No free fluid demonstrated and normal bowel sounds are
heard. Per-rectal examination reveals no abnormalities, hernial
orifices and genitalia are normal. Left supraclavicular notes are not
enlarged, Renal angles are normal

21. Provisional diagnosis
• Pseudocyst of pancreas