Minimally invasive treatment of a giant pancreatic pseudocyst.

The authors present minimally invasive treatment of a giant infected pancreatic pseudocyst. Throughout in-hospital period, the patient underwent endosonography-guided transgastric drainage of the pseudocyst, 7 endoscopic debridement of the cavity with sequestrectomy, laparoscopy for enzymatic peritonitis and external percutaneous drainage of the pseudocyst. Effectiveness of minimally invasive treatment was assessed considering laboratory data (CRP, white blood cell count), clinical data (hyperthermia, complaints) and follow-up ultrasound and computed tomography data (cyst dimension, sequestration). We observed with positive dynamics with decrease of intoxication syndrome, serum CRP and white blood cell count after two debridement procedures. After the seventh endoscopic debridement and sequestrectomy, granulations occurred in the cyst cavity and there was no further sequestration. At discharge, CT revealed dry residual small cavity 1.5×3 cm. There were no any complaints.