S4145 Endoscopic Management of Infected Pancreatic Pseudocyst Arising in Patient With Distal Pancreatectomy After Retention of a 14-Year-Old Stent

Introduction: 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 woman 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 endoscopic retrograde cholangiopancreatography (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 endoscopic ultrasound -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. Watch the video: https://tinyurl.com/25ACGS4145