A 45 year old alcoholic male with no history of pancreatitis presented with left flank pain after a fall. Evaluation at that time revealed left lower rib fractures. Two weeks later, he re-presented with epigastric fullness and early satiety. Abdominal CT scan showed a large, retro-gastric peri-pancreatic fluid collection. Aspiration of the cyst revealed fluid high in amylase and lipase.

Definitive treatment was delayed 2 more weeks to allow maturation of the cyst wall. We then performed a laparoscopic transgastric pancreatic cystgastrostomy. We first placed a percutaneous endoscopic gastrostomy tube. Through this, we placed a 5 mm trocar and insufflated the stomach. We then inserted two additional 5 mm trocars into the gastric lumen. We created a cystgastrostomy through the posterior wall of the stomach using an ultrasonic scalpel. After removing our trocars from the stomach, we closed the anterior gastrotomies with laparoscopic suturing.

The patient was discharged home on postoperative day 1 and was asymptomatic at 4 week follow up.

Laparoscopic transgastric pancreatic cystgastrostomy is a safe and effective technique for drainage of traumatic pancreatic pseudocysts.