Chronic pancreatitis with the development of pseudocysts: Case report of a rare course with retroesophageal extension to the mediastinum

Pancreatic pseudocysts are a common complication of pancreatitis. Although 20% regress spontaneously, persistent pseudocysts may lead to various complications such as infection: bleeding or compression of adjacent structures or organs. Due to the barrier function of the diaphragm, infection of pancreatic pseudocysts with posterior mediastinal extension represents a rare entity. Because of the rareness and untypical symptoms of such events, a mediastinal extension of an infected pancreatic pseudocyst often ist not recognized. In our case the expansion of the infection to the mediastinum had led to a compression of the dietal esophagus. Preoperative diagnostic evaluation was highly suggestive for a malignant distal esophageal tumor. A laparotomy was performed to further elucidate the origin of the mass. Intraoperative findings showed a pancreatic pseudocyst with infiltrative: extension of an infection from retrogstral to the lower mediastinum. After histologic preparations from intraoperative tissue samples had ruled out malignancy, we performed a cystojejunostomy of the pseudocyst and partial resection of the infected surrounding tis sue, Mediastinal masses with chronic pancreatitis should raise suspicion for extension of pancreatitis to the mediastinum. In our opinion: for this course of chronic pancreatitis operative intervention represent the standard for therapy.