Introduction : Pancreatic pseudocysts are known to cause biliary or duodenal obstruction. But jejunal obstruction due to pseudocyst is extremely rare.

Methods : A 55-year-old male presented with three days history of intestinal obstruction. In the past, patient had developed gallstone related acute pancreatitis two years prior which was managed conservatively. On examination, abdomen was distended with hyperperistaltic bowel sounds. Contrast enhanced computed tomography showed 9.3 x 7.8 x 9.8 cm pseudocyst involving body and tail of the pancreas. Main pancreatic duct was not dilated. The proximal jejunal loops were dilated with abrupt narrowing at the distal jejunum and collapsed distal bowel loops. The narrowed part of the jejunal loop was abutting the inferior aspect of the pseudocyst. Intraoperatively, the large pancreatic pseudocyst was found bulging from the mesocolon with the distal jejunal loop densely adhered to the pseudocyst causing intestinal obstruction with collapsed distal bowel loops. The pseudocyst was decompressed and the jejunal loop was separated from the cyst wall. Due to thin cyst wall, external drainage was performed.

Results : The operative time was 135 minutes with blood loss of 100 ml. Postoperative course was uneventful with hospital stay of 5 days. The drain was removed during the follow up at 20 days. Currently at one month after surgery, patient is symptom free.

Conclusions : Infra-colic extension of pancreatic pseudocyst can predispose to development of adhesions with the bowel loops leading to acute intestinal obstruction.