Excision of a giant pseudo-pancreatic cyst masquerading as ascites in young patient: a case report

Pancreatic pseudocysts are diagnosed more frequently due to increased usage of imaging techniques. A pseudocyst with diameter of 10 cm is defined as giant cyst. Larger and symptomatic pseudocysts require intervention while cysts upto 6 cm can be managed conservatively. A 16 year old young patient presented with abdominal pain, progressive abdominal distension, and breathlessness for 15 days. On examination, patient had tense distended abdomen with gross ascites. His vitals showed tachycardia, hypotension and tachypnea. After resuscitation, ultrasound showed gross ascites with moving echoes and contrast-enhanced computed tomography (CECT) abdomen showed similar findings. Patient underwent multiple therapeutic tapping of ascitic fluid but no significant improvement. Diagnostic laparoscopy showed giant pseudo pancreatic cyst extending from diaphragm to the pelvis with necrotic material. Patient underwent exploratory laparotomy, drainage of necrotic material with excision of giant pseudocyst and roux-en-y pancreaticojejunostomy. Post operatively patient had an uneventful recovery. Giant pancreatic pseudocysts are unusual and early management is required. Some experts considered external drainage is safer than cystogastrostomy. We suggest early diagnosis and surgical excision is feasible for a giant pancreatic pseudocyst. However, endoscopic drainage can be considered in some instances.

Rapidly Fatal Silicosis Among Jewellery Workers Attending a District Medical College of West Bengal, India.

Background. Silicosis is a slowly progressive chronic occupational lung disease, developed after a prolong period of exposure to high concentration of silica dust. Methods. In this longitudinal study, we enrolled old and new silicosis patients (n=19; 8 jewellery polishers, 11 from other occupations) seen at our Pulmonary Medicine Department from June 2009 to December 2012 to document the course of illness as per their occupational exposure. Results. Six of the eight jewellery polishing workers had developed silicosis within five years of exposure, while six of the 11 other workers with other occupational exposure had developed silicosis after exposure of 10 years or more. Mean duration of exposure was significantly less among jewellery polishing workers compared to other workers (3.4±1.7 versus 9.3±4.1; p=0.001). Mean duration of illness (months) (14.9±5.8 versus 28.5±16.5; p=0.040) were significantly less among the jewellery polishing workers compared to other workers. At the end of the study period, all eight jewellery polishing workers with silicosis had died while four of the 11 patients with other occupational exposure had died. Conclusion. Silicosis among jewellery polishing workers was found to be more severe and progressive compared to silicosis due to other occupational exposures, in our study.