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Symptomatic pancreatic body endometrial cyst requiring en bloc distal pancreatectomy
  1. Cameron Ludwig1,
  2. Avery Kopacz2,
  3. M Logan Warren2 and
  4. Edwin Onkendi3
  1. 1School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
  2. 2Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
  3. 3Surgery, Texas Tech University, Lubbock, Texas, USA
  1. Correspondence to Cameron Ludwig; cameron.ludwig{at}ttuhsc.edu

Abstract

Pancreatic endometriosis is an extremely rare condition, with only a few cases described in the literature. Definitive diagnosis is often difficult to elucidate and will almost always require biopsy or surgical resection. We present a case of a female in her early thirties with a well-known history of widespread endometriosis presenting with vague epigastric pain. CT imaging showed an 11 cm well-circumscribed simple-appearing cyst in the lessor sac. Its origin could not be determined preoperatively but it appeared to involve the parenchyma of the body of the pancreas. Due to the associated pain and indeterminate nature, subtotal surgical resection of the extrapancreatic cyst was performed with the intrapancreatic cyst being managed by a cystogastrostomy to the adjacent stomach in a planned pancreas-sparing procedure following intraoperative confirmation it was arising within the pancreas. Pathological evaluation of the resected cyst confirmed it to be an endometrial cyst. The cystogastrostomy anastomosis subsequently obstructed a few weeks postoperatively and symptoms recurred from cyst enlargement. Redo robotic resection with resection of the remnant cyst, cystogastrostomy and en bloc spleen-preserving distal pancreatectomy was performed. The patient had an uneventful recovery. She has had no recurrence of cyst or symptoms since. A procedure video is included in the report.

  • pancreas and biliary tract
  • reproductive medicine
  • drug therapy related to surgery
  • general surgery

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Footnotes

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  • Contributors CL created the original manuscript. AK contributed towards the bulk of the editing. MLW edited the manuscript and created the supplemental video. EO supervised and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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