Acute Pancreatitis with Large Infected Pseudo Pancreatic Cyst in a Post-Partum Female – Case Report

A frequent cause for patient presentation to the emergency department and the most serious gastrointestinal condition resulting in admission is acute pancreatitis. Pancreatitis is an inflammatory process within the pancreas. Although the disease is mostly mild, the mortality rate of severe forms may be up to 30 percent. Two of the following three criteria are required for diagnosis: epigastric abdominal pain, elevated lipase, and pancreatic inflammation on imaging.1 The occurrence of acute pancreatitis is approximately 1 in 1000 to 5000 births and is commonly seen in the last weeks of gestation or in post-partum period. Cholelithiasis, which accounts for more than 65 percent of cases, is the most common cause of acute pancreatitis in pregnancy.2 Pancreatic ascites results from persistent leakage of pancreatic secretions in the peritoneum from pancreatic duct injury. The extent of pancreatic ascites varies, depending on the site and degree of ductal damage and infection.3 The complications of acute or chronic pancreatitis are pancreatic pseudocysts. Initial diagnosis is mostly done by imaging. Endoscopic ultrasound with fine needle aspiration cytology (FNAC) has become the standard test to help differentiate pseudocyst from other cystic lesions of the pancreas. With supportive treatment, most pseudocysts resolve spontaneously. Poor predictors for the potential of pseudocyst resolution or complications are the size of the pseudocyst and the length of time the cyst has been present, but larger cysts in general are more likely to be symptomatic or cause complications.4 We report a case of young female presenting with jaundice and ascites two days post-partum, who was eventually diagnosed as a case of pancreatic ascites with large pancreatic pseudocyst.