Cystogastrostomy stent and pigtail catheter

Case contributed by Assoc Prof Craig Hacking

Presentation

Necrotizing pancreatitis with infected pseudocyst. Follow up.

Patient Data

Age: 60 years
Gender: Female

CXR

Long pigtail type tube with tip positioned in the left upper quadrant. There is a second short double pigtail tube also positioned within the left upper quadrant. The cystogastrostomy stent is poorly visible. Bilateral basal collapse/consolidation, more pronounced on the left. Cardiomediastinal contours are within normal limits. No free gas below the diaphragms.

AXR

Cystogastrostomy stent insitu with a double ended pigtail catheter extending through the stent. The coiled end of the nasogastric tube tip is projected over the stent. The exact location is difficult to define on the radiograph and hence subsequent CT has been performed. Mottled gas pattern in the upper abdomen, surrounding the stent due to gas within the pancreatic pseudocyst. Bowel gas pattern is within normal limits. No bony abnormality.

Nasogastric tube passes into the stomach, anterior to the cystogastrostomy stent with distal pigtail within the antrum of stomach. Small cystogastrostomy stent insitu with a short pigtail stent passing through this from the stomach into the pancreatic collection.

Two, rounded hyperdense foci in the dependent stomach most consistent with medication pills.

No pneumoperitoneum. Large, known pancreatic collection has maximal dimensions of 6 x 15 x 5cm (AP x trans x CC), similar to previous. Multiple gas locules within the collection.

Small mesenteric fat containing anterior abdominal wall hernia with no evidence of complication.

Pericholecystic fatty stranding.

Left basal atelectasis with adjacent pleural effusion.

IMPRESSION

Intended naso-cystic (pancreatic collection) tube distal portion is within the antrum of the stomach, not the pancreatic collection as understood to be intended.

Cystogastrostomy stent remains appropriately positioned with a smaller pigtail passing from the stomach through this into the pancreatic collection.

Large pancreatic collection with gas locules within.

Case Discussion

Cystogastrostomy stents are inserted to drain pancreatic pseudocysts into the stomach.

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Case information

rID: 75742
Published: 16th Apr 2020
Last edited: 16th Apr 2020
Inclusion in quiz mode: Included

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