Intramural gastric pseudocysts

Case contributed by Michael P Hartung
Diagnosis certain


Abdominal pain, history of recurrent alcoholic pancreatitis.

Patient Data

Age: 45
Gender: Female

There are perisplenic/subcapsular fluid collections consistent with pseudocysts. There is stranding in the left upper quadrant and a small pseudocyst at the pancreatic tail. 

There is extension of the splenic pseudocysts into the gastric fundus, with a portion of the cyst dissecting into the gastric wall through the body, with only a thin layer of the gastric mucosa separating the cyst from the lumen. 

Case Discussion

This case nicely illustrates that pseudocysts will often look for the path of least resistance. Over the period of weeks, this patient's splenic pseudocysts decompressed into the posterior gastric wall and now have an intramural course. There is only a thin layer of mucosa separating the cyst contents from the gastric lumen. In other words, this patient has nearly formed her own cyst gastrostomy. 

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