Intrathoracic Herniated and Infected Pancreatic Pseudocyst

A 40-year-old man was admitted with acute diarrhoea, 3 kg weight loss, and mild fever (up to 38 °C). His medical history included acute necrotising pancreatitis and an axial hiatal hernia. Laboratory tests showed elevated inflammation parameters (C-reactive protein of 188 mg/L). A 18 F-FDG-PET/CT scan revealed infected abdominal pancreatic pseudocysts extending to the thoracic region due to the hiatal hernia. Endosonography and transgastric drainage removed 200 mL of pus. Klebsiella pneumoniae was identified, and antibiotic therapy with ampicillin and sulbactam was started. A follow-up ultrasound showed significant cyst regression. The patient was discharged in a satisfactory condition with reduced inflammation.