Pseudo-pseudocysts of the pancreas

Pancreatic pseudocyst was erroneously diagnosed in three patients aged 52-57 years. Two patients had acute epigastric pain, hyperamylasemia (~4,000 IU/L), and a retrogastric collection of fluid demonstrated by early ultrasonography. Laparotomy undertaken within 48 h of admission revealed the correct diagnosis in each case. One patient had perforation of a gastric ulcer into the lesser sac, and the other patient (who died) had perforation of an obstructed afferent loop 25 years after Polya partial gastrectomy. The third patient with renal failure, back pain, and marginal hyperamylasemia had a cystic mass in the lesser sac. Two internal drainage operations were performed before the correct diagnosis of epithelioid leiomyoma was established 6 years later.