Clinical Case: Mass Abdomen

0
73

The patient 33 years old male presented to surgical OPD with complaints of pain abdomen and vomiting for last 4 weeks.

The patient was asymptomatic 4 weeks ago when he developed pain in epigastric region, which was gradual in onset, mild in intensity, and continuous. It was non radiating non shifting and was associated with vomiting.

Vomiting was non projectile, contained food particles, yellow in color and associated with intake of food.

Past History

The patient was admitted 4 months back with biliary pancreatitis. His cholecystectomy was done during same admission for gall stones. Post op he developed subhepatic fluid collection for which percutaneous drainage was done.

There was no past history of ischemic heart disease, hypertension, asthma or any other disease. His drug and family history was unremarkable. He was a non smoker and non addict. He belonged to lower socioeconomic class.

Examination

On general physical examination, the patient was an averagely built man lying comfortably, well oriented in time place & person with stable vital signs. Rest of the general physical examination was normal.

On abdominal examination a scar mark of cholecystectomy in right subcostal regin was visible along with a local mass measuring 7.3×15.3  cm in epigastric region. Rest of the abdominal examination revealed no abnormality.

On the basis of history and clinical examination, a differential diagnosis of pancreatic psuedocyst, CA pancreas, pancreatic abscess, acute/chronic pancreatitis, SOL liver, stomach growth, lymphadenopathy or mass arising from transverse colon was made.

Investigations

His blood complete picture, liver function tests, renal function tests and coagulation profile were normal. Hepatitis serology and chest X ray were normal.

USG abdomen revealed a cystic structure measuring 7.3 x 13.5 cm in epigastric region with a provisional diagnosis of pancreatic psuedocyst.

CT scan confirmed the presence of 8.3 x9.5×16.1 cm cyst in the lesser sac with 663 ml fluid inside the cyst.

On the basis of history clinical examination and investigations a final diagnosis of pancreatic pseudocyst was made.

Management

Initial management included admittance to the ward, inj Ringer lactate 1000 ml @ 30 drops per min, inj  Toradol (ketorolac) 30mg/100ml saline IV BDand inj  Risek (omeprazole) 40mg IV BD.

Definitive managment of pancreatic cycstogastrostomy was planned. The plan was to drain the pseudocyst via cystogastrostomy.

Pre-operatively patient was kept nill per oral 8 hours before surgery, NG tube and Foley’s catheter were passed, IV line was maintained, antibiotics were started and pre anesthesia assessment was done.

General anesthesia was given. 500 ml fluid was removed which was clear watery in nature.

This slideshow requires JavaScript.

Post operatively, the patient made a smooth recovery. He was kept NPO for 03 days. NG tube was removed on 3rd post operative day.

He was kept on IV antibiotics, IV fluids, IV proton pump inhibitors and IV analgesics.