# Acute Necrotizing Pancreatitis With Early Pseudocyst Formation Following Uncomplicated Laparoscopic Cholecystectomy: A Rare Postoperative Complication

## TL;DR

A rare case of acute necrotizing pancreatitis with pseudocyst formation occurred after a routine gallbladder surgery, highlighting the need for careful monitoring and management.

## Contribution

This case report highlights the rare occurrence of pseudocyst formation following uncomplicated cholecystectomy without biliary obstruction.

## Key findings

- Acute necrotizing pancreatitis with pseudocyst formation occurred two weeks after an uncomplicated laparoscopic cholecystectomy.
- The patient required ERCP with pancreatic duct stent placement to manage ductal pressure and improve clinical outcomes.
- Pseudocyst formation after cholecystectomy without biliary obstruction is exceptionally rare and requires multidisciplinary care.

## Abstract

We present the case of a 60-year-old woman who was admitted with acute pancreatitis, cholelithiasis, and cholecystitis, and subsequently underwent an uneventful laparoscopic cholecystectomy. Two weeks postoperatively, she returned to the hospital with severe epigastric pain radiating to the back, accompanied by nausea and vomiting. Contrast-enhanced computed tomography (CT) imaging revealed acute necrotizing pancreatitis with early pancreatic pseudocyst formation at the junction of the pancreatic body and tail, without evidence of biliary obstruction or retained stones. She was managed with intravenous fluids, broad-spectrum antibiotics, bowel rest, analgesia, and underwent endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stent placement to reduce ductal pressure. She improved clinically and was discharged after one week of hospitalization, but returned two weeks later with signs of sepsis. Pancreatic pseudocysts are rare complications of pancreatitis, more often associated with chronic cases, and typically develop several weeks after inflammation or ductal injury. Their occurrence following an uncomplicated cholecystectomy in the absence of biliary obstruction or retained stones is exceptionally uncommon. This case underscores the diagnostic and management challenges of post-cholecystectomy pancreatitis complicated by pseudocyst formation and highlights the importance of interval imaging, multidisciplinary evaluation, and conservative management in stable patients. Awareness of this rare complication is essential to prevent unnecessary interventions while ensuring timely escalation of care when indicated.