Although surgical drainage of pancreatic pseudocysts has been superseded by less invasive options, the requirement for specialized equipment, technical expertise, and consumables limits the options available in low resource settings. We describe the challenges experienced during endoscopic transmural drainage in a low resource setting and the methods used to overcome these barriers. Despite operating in a low resource environment, endoscopic drainage of pancreatic pseudocysts can be incorporated into our armamentarium with minimal change to the existing hardware. Careful patient selection by a dedicated multidisciplinary team should be observed in order to achieve good outcomes. 1. Introduction Disruption of the pancreatic ducts can produce an acute fluid collection that matures to become surrounded by a fibrous capsule due to the chronic inflammatory reaction. The resulting pancreatic pseudocyst [1–3] may become complicated by haemorrhage, intestinal obstruction, infection, or rupture. When complications develop, pseudocysts require some form of drainage [3, 4]. The traditional open surgical approach has now been superseded by less invasive options such as percutaneous drainage [3] or endoscopic drainage [4]. The advantages of these less invasive options are balanced by the need for technical expertise, specialized equipment, and increased cost. Therefore, these options are not universally available in low resource settings in developing countries [3, 5]. We report the challenges encountered in the low resource setting when performing endoscopic cystogastrostomy for pancreatic pseudocysts. To the best of our knowledge this is the first report of endoscopic cystogastrostomy from the Anglophone Caribbean. 2. Report of a Case A 14-year-old boy presented to the emergency department eight weeks after being kicked in the epigastrium during a football match. He reported getting worse and nonbilious vomiting associated with an enlarging, tender epigastric mass. He could only tolerate small volumes of fluids orally. On presentation he was mildly dehydrated, afebrile, and anicteric. There was upper abdominal distention associated with a firm epigastric mass. The mass was tender on deep palpation but there was no guarding or rebound tenderness. Bowel sounds were normal and a succussion splash was not present. The respiratory and cardiovascular examinations were normal. Liver function tests and serum amylase were normal. Abdominal ultrasound revealed a ？cm cystic mass occupying the entire lesser sac, interposed between stomach and pancreas. Multiphase computer
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