Surgical Management of Pancreatic Pseudocyst Following Acute Pancreatitis — A Case by Dr. Manoj Dongare
How an 8 cm Pancreatic Pseudocyst Was Successfully Treated with Cystogastrostomy in Pune
Pancreatitis is a painful and potentially serious condition — and when it leads to complications like a pancreatic pseudocyst, timely and expert management becomes absolutely critical. This is the story of a 35-year-old gentleman whose acute pancreatitis led to a large pseudocyst, and how Dr. Manoj Dongare successfully treated it with a well-planned surgical procedure.
The Patient and His Presenting Complaint
A 35-year-old male patient with a history of chronic alcohol consumption presented with severe abdominal pain. After thorough clinical evaluation and imaging, he was diagnosed with acute pancreatitis with fluid collection around the pancreas.
Alcohol-related pancreatitis is one of the most common causes of acute pancreatitis in India, particularly in young and middle-aged men. The pancreas becomes severely inflamed, and in many cases, fluid begins to collect around it — which can later develop into a pseudocyst if not managed properly.
The patient was referred to Dr. Manoj Dongare, one of the best HPB Surgeons and best Pancreatic Surgeons practising at D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune and Cloverleaf Speciality Clinic, Wakad, Pune-PCMC.
Initial Management — Conservative Approach First
Not every case of pancreatitis requires immediate surgery. In this case, Dr. Manoj Dongare followed the correct and evidence-based approach of conservative management first.
Initial conservative treatment included:
Complete bowel rest and nil by mouth
Intravenous fluids and nutritional support
Pain management and monitoring
Close observation for signs of complications
This careful, non-surgical approach in the acute phase is standard practice and gives the pancreas time to settle down before any intervention is considered.
Follow-Up Imaging — The Pseudocyst is Discovered
Six weeks after the initial episode of pancreatitis, the patient underwent follow-up imaging as planned.
What the imaging revealed:
An 8 cm pancreatic pseudocyst — a large, fluid-filled sac that had formed adjacent to the pancreas
The pseudocyst had not resolved on its own despite conservative management
What is a Pancreatic Pseudocyst?
A pancreatic pseudocyst is a collection of fluid that forms after an episode of pancreatitis. Unlike a true cyst, it does not have a proper lining. It develops when the pancreatic ducts are disrupted and pancreatic fluid leaks out and collects in a enclosed space.
When does a pseudocyst need treatment?
When it is large (generally more than 6 cm)
When it causes symptoms like pain, nausea, or vomiting
When it does not resolve on its own after several weeks
When there is a risk of infection or rupture
In this patient's case, the 8 cm size and persistent symptoms clearly indicated that surgical intervention was necessary.
The Surgery — Cystogastrostomy
Dr. Manoj Dongare performed a Cystogastrostomy — a well-established and highly effective surgical procedure for draining pancreatic pseudocysts.
What is Cystogastrostomy?
Cystogastrostomy is a surgical procedure in which the pancreatic pseudocyst is connected directly to the stomach. This creates an internal drainage pathway, allowing the fluid inside the pseudocyst to drain naturally into the stomach and pass out of the body through the digestive system.
Step-by-step surgical process:
Patient preparation and anaesthesia — The patient was prepared for general anaesthesia
Surgical access — The abdomen was opened to access the pseudocyst
Identification of the pseudocyst — The 8 cm cyst was identified adjacent to the posterior wall of the stomach
Creation of the cystogastrostomy — An opening was created between the pseudocyst and the stomach wall, allowing internal drainage.
Closure and completion — The surgical site was closed carefully after confirming adequate drainage
This procedure effectively eliminates the pseudocyst by using the body's own digestive system as a natural drainage route — avoiding the need for repeated external drainage or more complex surgery.
Post-Operative Recovery — Smooth and Straightforward
Following the surgery by Dr. Manoj Dongare, the patient's recovery was excellent.
Post-operative course:
Day 1–4 — Patient monitored closely; pain well controlled
Day 5–6 — Gradual introduction of oral diet; patient tolerating well
Day 7 — Patient discharged in good condition
Follow-up — Patient is currently doing well with no complications
Being discharged on Postoperative Day 7 after a cystogastrostomy is an excellent outcome and reflects the high standard of surgical care provided.
If you or a loved one has been diagnosed with pancreatitis, pancreatic pseudocyst, or any complex pancreatic condition, do not delay seeking expert care.
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