Journal of Clinical and Diagnostic Research (Jul 2025)
Pneumoperitoneum in Ruptured Pancreatic Pseudocyst without Hollow Viscus Organ Perforation: A Case Report
Abstract
Pancreatic pseudocysts are a recognised complication of pancreatitis, often resolving with conservative management. However, spontaneous rupture of a pseudocyst into the peritoneal cavity is a rare and life-threatening event. This is a case of a 64-yearold female with a history of diabetes mellitus, hypertension, Chronic Kidney Disease (CKD), systemic amyloidosis, and recurrent pancreatitis who presented with epigastric pain, shortness of breath, vomiting, and fever. Clinical evaluation revealed peritonitis, leukocytosis, markedly elevated inflammatory markers, and renal dysfunction. Elevated serum amylase and lipase levels supported the suspicion of pancreatitis. A plain Computed Tomography (CT) abdomen, performed due to renal impairment, revealed pneumoperitoneum with suspected gastric perforation and a large intra-abdominal collection. Exploratory laparotomy revealed no hollow viscus perforation but rupture of a pancreatic pseudocyst with approximately 450 mL of purulent fluid in the peritoneal cavity. The pseudocyst wall was partially excised, and intra-abdominal lavage was performed. Drain fluid analysis confirmed high amylase and lipase content. Histopathological examination of the cyst wall confirmed the diagnosis of a pancreatic pseudocyst with acute necrotising inflammation. The patient was managed with octreotide, haemodialysis, and Vacuum-Assisted Closure (VAC) dressing for wound complications. She recovered and was discharged on postoperative day 25 with instruction for follow-up. This case highlights the importance of considering ruptured pseudocyst in patients with a history of pancreatitis presenting with acute abdomen and pneumoperitoneum, especially when imaging mimics gastrointestinal perforation. Prompt surgical intervention and supportive care are crucial for favourable outcomes in such complex cases.
Keywords
