Persistent severe abdominal pain.

A 68 y/o male presented with moderate to severe abdominal pain. CT scan was done which shows a 12 mm pseudocyst in the pancreatic body. Surgical drainage was done. The surgery was uneventful but abdominal pain persists even after 1 week of surgery. What could be the cause of persistent pain?

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Patient needs further evaluation by A repeat CECT abdomen to look for resolution of the pseudocyst . Sometimes- pain may persist after surgery - there are many factors 1.APD 2.Pain at the wound site due to underlying wound infection 3.Abdominal dyspepsia

12 mm is too small a size of pseudocyst to be drained, at this age pseudocyst is relatively uncommon.. It raises a possibility of cystic neoplasm of pancreas What's surgery was done? Was biopsy taken from cyst and sent for histopathology? What is pathology report Complete evaluation can help in deciding treatment

Psuedpancreatic cyst aspirated C/o pain abdomen Resurgence of cyst needs to go for usg or ct abdomen If cyst is leakage likely peritonitis Pancreatitis APD gastritis So investigate and treat accordingly

Persistent pain even after surgery is due to 1) Ineffective drainage, 2) Multiple cysts which can be missed during intial examination/surgery, 3) Recurrence of cyst, 4) Pancreatic leak, 5) Peritonitis, 6) Wound infection, 7) Pancreatic aneurysm. Do CT abdomen,Amylase,lipase levels.

Needs further investigation and evaluation to conclude till reports complied. Antispasmodic. * haematoma or sepsis ** peritonitis.

Thanks Dr SI Godara
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Mustakaristha 2tsp twice a day.sanjeevini vati 1 tablet twice daily for 1 week.Ample water , buttermilk and pomegranate juice.

Need complete evaluation Take ultrasound abdomen and pelvis Check for any signs of sepsis Peritonitis Start antispasmodics

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