Case of the Month, July 2018

Submitted by  Stephen Chan, MD and Thomas Learch, MD.

History of Present Illness

49-year-old female presents with aching epigastric pain that radiates to the left upper quadrant for the past week. She was diagnosed with gastritis 1 month ago and started on omeprazole. She has also had nausea with 3-4 episodes of nonbloody nonbilious emesis in the past week. Denies hematemesis.

Past Medical History

Hospitalized for acute pancreatitis 17 years ago, denies any other episodes Gastritis diagnosed 1 month ago

Past Surgical History


Social History
  • Lives with son and husband. Not employed.
  • Tobacco: â…“ pack per day for the last 35 years
  • Alcohol: 1 pint hard liquor per day for the last 10 years
  • Other: Denies other substances

Omeprazole 10mg oral per day

Review of Systems

Positive for abdominal pain, nausea, and vomiting. Otherwise negative.

  • Pulse: 98 bpm
  • Respiratory Rate: 18
  • Blood Pressure: 124/82
  • Temperature: 98.5 F
  • Oxygen Saturation: 99%
Physical Exam
  • Well appearing female in no acute distress, with mild epigastric/left upper quadrant tenderness.
  • No rebound or guarding.

CBC and CMP within normal limits.

Abdominal ultrasound was ordered:


Ultrasound showed large complex cystic masses adjacent to the left kidney and liver. Abdominal CT was performed for further evaluation.






CT showed pancreatic calcifications and a large fluid collection inseparable from the pancreas, liver, stomach, and left kidney- likely a pancreatic pseudocyst.

Endoscopic ultrasound was performed. A pseudocyst was identified with a 45mm x 30 mm portion adjacent to the pancreas, which was drained uneventfully via cystogastrostomy. Other findings included pancreatic calcifications consistent with moderate-severe chronic pancreatitis as well as mild gastritis. 

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