Spontaneous rupture of a pancreatic pseudocyst: BMJ case rep
This is a case of a 50-year-old woman with medical history significant for chronic pancreatitis secondary to alcohol abuse who initially presented with a 3-week history of progressively worsening epigastric pain. The patient described the pain as sharp, radiating to the back, worsened with intake of both solid foods and liquids and relieved with self-induced emesis.

On admission, the patient was hypertensive, but other vitals were within normal limits. The abdomen was soft; however, there is a firm palpable mass extending from the epigastric to the right and left upper quadrants. Labs were remarkable for hypokalaemia with potassium (K) 3 meq/L (normal range 3.5–4.9 meq/L), mildly elevated lipase 132 U/L (7–60 U/L) and an elevated alkaline phosphatase of 164 U/L (41–108 U/L).

CT of the abdomen with contrast revealed a large cystic structure measuring 12.9×21.2 cm directly adjacent to the body of the pancreas and a fluid collection with enhancing rim measuring 4.8×6.6 cm near the pancreatic tail with subsequent displacement of the stomach. Gastroenterology recommended cyst-gastrostomy at a tertiary care centre. However, surgery recommended surgical cyst-gastrostomy in the facility.

The patient was made nil per os and started on total parenteral nutrition. Patient declined pain medications. Four days after admission, the patient started complaining of sudden worsening of the abdominal pain. Abdomen examination remained unchanged from admission and no interval imaging studies were performed.

Learning points
• Pancreatic pseudocyst rupture is a rare complication that may warrant immediate surgical intervention if it causes signs of peritonitis.

• A sudden increase in abdominal pain with or without signs of peritonitis warrants further investigation to rule out possible pseudocyst rupture.

• Pancreatic pseudocysts which rupture into hollow organs may resolve spontaneously without causing any complications.

Read in detail here: http://casereports.bmj.com/content/2018/bcr-2018-226296.full