Pancreaticopleural fistula and mediastinal extension: a case report of two unusual presentations of pancreatic pseudocyst in a resource-limited setting

Introduction and Importance: Thoracic manifestations of pancreatic pseudocyst are unusual with atypical symptoms. Presentation of Cases: Herein, we report one case of pancreatico-pleural fistula with massive pleural effusion and another one of mediastinal extension, as presentation of pancreatic pseudocyst in two adult patients in a limited setting. Dyspnea was the main symptom in both cases. These patients were alcoholics with non-documented past-history of acute pancreatitis. For the pancreatico-pleural fistula, percutaneous chest drainage was performed to relieve breathlessness, followed by definitive surgical management with open cystojejunostomy. The mediastinal extension was managed by a laparoscopic cystogastrostomy. The postoperative course was uneventful in both cases. The follow-up CT-scan, 6 weeks after surgery, showed a complete cyst resolution in both cases. Clinical Discussion: It’s unusual to discover a pancreatic pseudocyst as the aetiology of a patient received for dyspnea. The absence of endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, and therapeutic endoscopy in our context necessitates reliance on CT-Scan, rescue percutaneous drainage, and open/laparoscopic drainage, all successfully employed here. Conclusion: A pancreatic pseudocyst may have mediastinal extension or fistulize into the pleural cavity leading to massive pleural effusion. These two entities should be considered as possible differential diagnoses during the investigation of a dyspnea.