Background : Pancreatic pseudocysts are uncommon complications of acute and chronic pancreatitis. Rarely, they can complicate with an acute rupture into the abdominal cavity. Although guidelines are available, it is focused on elective management and data is limited on emergent cases. We present a 26-year-old male referred for treatment of a large pancreatic pseudocyst. He had a one month history of epigastric pain with a growing upper abdominal mass following a previous abdominal trauma. On examination he had a surgical abdomen and sonography showed significant decrease in the cyst size with massive ascites.

Methods : After aggressive resuscitation and initiation of intravenous antibiotics, he was brought to the operating room for emergent laparotomy. Intraoperatively, there was massive ascites and fibrin septations and a 2x2 cm perforation near the area of the pancreatic tail. A Roux- en-Y cystojejunostomy was done with temporary abdominal closure using the Bogota bag technique.

Results : Fascial closure was achieved at 72 hours post-operation after clinical improvement. He contracted Covid-19 during the admission but was discharged well after the 8th postoperative day. No recurrence of the pseudocyst was confirmed by ultrasound at the one month post-operation follow up.

Conclusions : Pseudocyst complications can range from hemorrhage, obstruction and acute perforation. Rupture into the abdominal cavity is a rare devastating complication that can present as a surgical abdomen with limited data on management and outcome. This case highlights that cystoenteric bypass can be safely done in emergent conditions and how temporary abdominal closure can avoid complications of abdominal compartment syndrome.