Surgical Intervention for Mediastinal Pancreatic Pseudocysts. A Case Series and Review of the Literature

  • Dafni Metaxa Department of Hepatopancreaticobiliary Surgery, Addenbrooke’s Hospital. Cambridge, United Kingdom
  • Anita Balakrishnan Department of Hepatopancreaticobiliary Surgery, Addenbrooke’s Hospital. Cambridge, United Kingdom
  • Sara Upponi Department of Radiology, Addenbrooke’s Hospital. Cambridge, United Kingdom
  • Emmanuel L Huguet Department of Hepatopancreaticobiliary Surgery, Addenbrooke’s Hospital. Cambridge, United Kingdom
  • Raaj K Praseedom Department of Hepatopancreaticobiliary Surgery, Addenbrooke’s Hospital. Cambridge, United Kingdom
Keywords: Mediastinum, Pancreas, Pancreatic Pseudocyst


Context Development of mediastinal pancreatic pseudocysts is a rare complication of pancreatitis. There is currently no consensus on the optimal management of this condition, options for which include conservative management with somatostatin analogues, endoscopic drainage procedures and surgery. Case report Here we present two patients with mediastinal pancreatic pseudocysts which were initially managed endoscopically. However, in both cases, this led to complications secondary to the endoscopic procedures, recurrence or non-resolution of symptoms, requiring surgical cystogastrostomy and/or cystojejunostomy. Conclusion These cases suggest that surgery may be ultimately necessary for mediastinal pancreatic pseudocysts where endoscopic procedures might have a high likelihood of failure.

Image: A well-defined rim enhancing pseudocyst.


Download data is not yet available.


Johnston RH Jr, Owensby LC, Vargas GM, G.-R. R. Pancreatic Pseudocyst of the Mediastinum. Ann Thorac Surg 1986; 41, 210–212. [PMID: 3947175]

Sadat U, Jah A, Huguet E. Mediastinal extension of a complicated pancreatic pseudocyst; a case report and literature review. J Med Case Rep 2007; 1: 12. [PMID: 17459155]

Gupta R, Munoz JC, Garg P, Masri G, Nahman NS, Lambiase LR . Mediastinal pancreatic pseudocyst--a case report and review of the literature. Med Gen Med 2007; 9: 8. [PMID: 17955064]

Komtong S, Chanatrirattanapan R, Kongkam P, Rerknimitr R, Kullavanijaya P. Mediastinal pseudocyst with pericardial effusion and dysphagia treated by endoscopic drainage. JOP. J Pancreas (Online] 2006; 7(4): 405–10. [PMID: 16832138]

Musana KA, Yale SH, Abdulkarim A, Rall CJ. Successful endoscopic treatment of mediastinal pseudocysts. Clin. Med. Res 2004; 2: 119–23. [PMID: 15931345]

Suga H, Tsuruta O, Okabe Y, Saitoh F, Noda T, Yoshida H, et al. A case of mediastinal pancreatic pseudocyst successfully treated with somatostatin analogue. Kurume Med J. 2005; 52, 161–164. [PMID: 16639988]

Bhasin DK, Rana SS, Chandail VS, Nanda M. CASE REPORT Successful Resolution of a Mediastinal Pseudocyst and Pancreatic Pleural Effusion by Endoscopic Nasopancreatic Drainage. JOP. J Pancreas (Online) 2005; 6(4): 359–364. [PMID: 16006688]

Gornals JB, Loras C, Mast R, Botargues JM, Busquets J, Castellote J, et al. Endoscopic ultrasound-guided transesophageal drainage of a mediastinal pancreatic pseudocyst using a novel lumen-apposing metal stent. Endoscopy 2012; 44, E211–2. [PMID: 22622750]

Kim DJ, Chung HW, Gham CW, Na HG, Park SW, Lee SJ, et al. A Case of Complete Resolution of Mediastinal Pseudocyst and Pleural Effusion by Endoscopic Stenting of Pancreatic Duct. Yonsei Med J 2003; 44: 727–731. [PMID: 12950133]

Mohl W, Moser C, Kramann B, Zeuzem S, Stallmach A. Endoscopic transhiatal drainage of a mediastinal pancreatic pseudocyst. Endoscopy 2004; 36: 467. [PMID: 15100970]

Rana SS, Bhasin DK, Rao C, Singh H, Sharma V, Singh K. Esophageal stricture following successful resolution of a mediastinal pseudocyst by endoscopic trans- papillary drainage. Endoscopy 2012; 44, 121–122. [PMID: 22477176]

Chang YC, Chen CW. Thoracoscopic drainage of ascending mediastinitis arising from pancreatic pseudocyst. Interact. Cardiovasc. Thorac. Surg 2009; 9: 144–5. [PMID: 19386659]

Belágyi T, Issekutz A, Paukovics A, Kecskés G, Oláh A. Successful treatment of mediastinal pancreatic pseudocyst by pancreatic head resection. JOP 2008; 9: 346–9. [PMID: 18469452]

Libby ED, Taylor J, Mysh D, Schwaitzberg SD. Combined Laparoendoscopic Cystgastrostomy. Gastrointest. Endosc 1999; 50: 416–419. [PMID: 10462669]

Monteban-Kooistra WE, Meertens JHJM, van der Werf TS. Mediastinal mass. Neth J Med 2005; 63: 407- 417. [PMID: 16301762]

Obuszko Z, Beggs D. Dysphagia due to pancreatic pseudocyst with mediastinal extension. Eur J Cardiothorac Surg 1998; 13: 316–8. [PMID: 9628385]

Lillemoe KJW. Hepatobiliary and Pancreatic Surgery. Philadeplphia: Lippincott Williams and Wilkins 2013. [ISBN: 978-1608311729]

Aghdassi AA, Mayerle J, Kraft M, Sielenkaemper AW, Heidecke CD, Lerch MM. Pancreatic pseudocysts--when and how to treat? HPB (Oxford) 2006; 8: 432–41. [PMID: 18333098]

Heider R, Meyer AA, Galanko JA, Behrns KE. Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients. Ann Surg 1999; 229, 781–7; discussion 787–9. [PMID: 10363891]

Cooperman AM. Surgical treatment of pancreatic pseudocysts. Surg Clin North Am 2001; 81: 411–9. [PMID: 11392428]

Libera ED, Siqueira ES, Morais M, Rohr MRS, Brant CQ, Ardengh JC et al. Pancreatic pseudocysts transpapillary and transmural drainage. HPB Surg 2000; 11: 333–338. [PMID: 10674749]

Mallavarapu R, Habib TH, Elton EGM. Resolution of Mediastinal Pancreatic Pseudocysts with Transpapillary Stent Placement. Gastrointest Endosc 2001; 53: 367–370. [PMID: 11231406]

Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T et al. Complications of ERCP. Gastrointest Endosc 2012; 75: 467–73. [PMID: 22341094]

Jacobson BC, Adler DG, Davila RE, Hirota WK, Leighton JA, Qureshi WA et al. ASGE guideline: complications of EUS. Gastrointest Endosc 2005; 61: 8–12. [PMID: 15672049]

A well-defined rim enhancing pseudocyst
How to Cite
MetaxaD., BalakrishnanA., UpponiS., HuguetE., & PraseedomR. (2015). Surgical Intervention for Mediastinal Pancreatic Pseudocysts. A Case Series and Review of the Literature. JOP. Journal of the Pancreas, 16(1), 74-77.