PMC3113193_01
(A) Computed tomography of the abdomen demonstrates a cystic lesion in the tail of the pancreas and an intestinal structure (arrow) between the cyst (arrowheads) and the stomach (single short arrow). (B) An upper gastrointestinal series shows extramural compression along the greater curvature of the upper body of the stomach.
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F1
Abdominal ultrasonography, CT (Figure 1A), and magnetic resonance imaging all demonstrated a homogeneous cystic mass, 9 x 4 cm in size, at the tail of the pancreas. An upper gastrointestinal series showed extramural compression along the greater curvature of the upper body of the stomach (Figure 1B). CT (Figure 1A) and endoscopic ultrasonography revealed a part of the intestine between the cyst and gastric wall.
(A) The round, smooth surface of the cyst, which was not adherent to the surrounding tissue, was exposed by dissection of the lesser sac. (B) Each blade of an endoscopic linear stapler was inserted into the small cystotomy and gastrotomy openings on the lesser curvature to create a large anastomosis.
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F2
Treitz ligament, probably during the previous surgery, was pulled out. The pseudocyst was exposed by dissecting the lesser curvature of the stomach (Figure 2A). Tokyo, Japan) was inserted into each opening, and a large anastomosis was created (Figure 2B).
A postoperative upper gastrointestinal series shows the contrast medium in the stomach (arrow) passes quickly into the cyst (arrowheads).
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F3
A large communication between the cyst and the stomach was shown by an upper gastrointestinal series on day 8 after surgery (Figure 3) and the postoperative course was uneventful.