BJU International (2002), 90 © 2002 BJU International 1 doi:10.1046/j.1464-4096.2002.02927.x Blackwell Science, LtdOxford, UK BJUBJU International1464-4096BJU International 907November 2002 2927 PANCREATIC PSEUDOCYST M. LEKILI et al. 10.1046/j.1464-4096.2002.02927.x Case report••••BEES SGML CASE REPORT A rare complication of radical nephrectomy: a pancreatic pseudocyst M. LEKILI, T. COSKUN*, I. GUNDUZ, G. TEMELTAS and C. BUYUKSU Departments of Urology and *General Surgery, Celal Bayar University School of Medicine, Manisa, Turkey Case report A 48-year-old woman presented with a painless mass in the left kidney, discovered incidentally during abdominal ultrasonography. The renal tumour was removed via an anterior abdominal approach. After radical nephrectomy there were no early complications. Histological examina- tion revealed stage II RCC (Robson classification). At the 3-month follow-up she presented with left flank pain. A detailed evaluation included CT and MRI, which showed a large cystic mass overlying the operated renal fossa (Fig. 1). The left flank was explored to clarify the nature of the mass. A pancreatic pseudocyst was diagnosed after surgery, the key to the diagnosis being the high amylase content of the fluid collected during the surgical interven- tion. Treatment comprised the administration of soma- tostatin (0.2 mg daily) for 2 weeks. Spontaneous closure occurred on the 15th day of therapy and an additional surgical procedure was not required. Comment A particularly distressing complication of radical nephre- ctomy is the development of a pancreatic fistula caused by unrecognized intraoperative injury to the pancreas. This complication is usually apparent immediately after sur- gery, with signs and symptoms of acute pancreatitis and drainage of alkaline fluid from the incision [1]. There was no such drainage in the present patient, but instead there was a well delineated cystic mass detected later in the left retroperitoneum. Treatment involves either percutaneous or surgical drainage of the fluid collection to avoid the development of a pancreatic pseudocyst or abscess. Most fistulae close spontaneously with adequate drainage, and surgical closure is only occasionally necessary [2]. Dys- function of the sphincter of Oddi is common in patients with acute nonbiliary pancreatitis and in most cases somatostatin can be used to relax the sphincter [3]. This relaxation provides adequate drainage of pancreatic fluid, allowing spontaneous closure of the fistula. Any patient with a fluid collection in the kidney region after nephre- Fig. 1. A CT scan ( a ) showing the cystic mass in the left retroperito- neum, and ( b ) an MR image of the same lesion. a a b