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Chhabra M, Gupta P, Shah J, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U, Kochhar R. Imaging Diagnosis and Management of Fistulas in Pancreatitis. Dig Dis Sci 2024; 69:335-348. [PMID: 38114791 DOI: 10.1007/s10620-023-08173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/27/2023] [Indexed: 12/21/2023]
Abstract
Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous drains or external wound (following surgery) due to the communication of the peripancreatic collection with the main pancreatic duct (MPD). Internal pancreatic fistulas include communication of the pancreatic duct (directly or via intervening collection) with the pleura, pericardium, mediastinum, peritoneal cavity, or gastrointestinal tract. Cross-sectional imaging plays an essential role in the management of pancreatic fistulas. With the help of multiplanar imaging, fistulous tracts can be delineated clearly. Thin computed tomography sections and magnetic resonance cholangiopancreatography images may demonstrate the communication between MPD and pancreatic fluid collections or body cavities. Endoscopic retrograde cholangiography (ERCP) is diagnostic as well as therapeutic. In this review, we discuss the imaging diagnosis and management of various types of pancreatic fistulas with the aim to sensitize radiologists to timely diagnosis of this critical complication of pancreatitis.
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Affiliation(s)
- Manika Chhabra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Tomey V, Tomey S, Choudhari-Joshi MA, Singh C, Aurangabadkar GM. Outlandish pancreatic pseudocyst: A case report. J Family Med Prim Care 2023; 12:3418-3421. [PMID: 38361871 PMCID: PMC10866256 DOI: 10.4103/jfmpc.jfmpc_1136_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 02/17/2024] Open
Abstract
Pseudocysts in the perinephric region are rare and pose a diagnostic dilemma. We present the case of a 54-year-old male with left perirenal pancreatic pseudocyst. The diagnosis was enabled via proper clinical history taking and imaging investigations. The patient was successfully managed with definitive primary surgical treatment. This report highlights difficulties in diagnosis and treatment.
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Affiliation(s)
- Vandana Tomey
- Department of Surgery, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Nagpur, Maharashtra, India
| | - Sudhir Tomey
- Department of Surgery, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Nagpur, Maharashtra, India
| | | | - Chahat Singh
- Department of Surgery, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Gaurang M. Aurangabadkar
- Department of Respiratory Medicine, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Nagpur, Maharashtra, India
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3
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Madani MA, Ouannes Y, Chaker K, Marrak M, Nouira Y. Pancreatic pseudocyst mimicking a left kidney abscess: a case report. J Med Case Rep 2023; 17:228. [PMID: 37254204 DOI: 10.1186/s13256-023-03957-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Pancreatic pseudocyst are fluid filled sacs that develop as a result of dissection of pancreatic enzyme tissue. While most commonly found near the pancreas, they can also rarely occur in other areas such as the perirenal region. CASE PRESENTATION This study reports a new case of an infected perirenal pancreatic pseudocyst mimicking a left kidney abscess in a 46-year-old North African patient with history of recurrent acute pancreatitis, who presented with left lumbar region pain and fever. Computed tomography revealed a left perirenal collection that turned out to be an infected pancreatic pseudocyst, The diagnostic was first suspected based on the medical history of the patient and confirmed by biochemical examination detecting a high level of pancreatic enzymes in the computed tomography-guided percutaneous drainage fluid. The patient evolved well after early resuscitation, rapid and effective antibiotic therapy, and computed tomography-guided percutaneous drainage of renal collection. CONCLUSION Pancreatic pseudocyst is an uncommon disorder, which may present at a complicated stage and that must be considered in patients with a history of pancreatitis.
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Affiliation(s)
- Mohamed Anouar Madani
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia.
| | - Yassine Ouannes
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
| | - Kays Chaker
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
| | - Mahdi Marrak
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
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4
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Harish C S, Dixit R, Singh S, Prakash A. Cervical extension of pancreatic pseudocyst: An unusual cause of neck stiffness and dysphagia. SA J Radiol 2022; 26:2385. [PMID: 35747785 PMCID: PMC9210193 DOI: 10.4102/sajr.v26i1.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/01/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sneha Harish C
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Sapna Singh
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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5
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Abstract
AbstractInterventional endoscopy is now considered an effective minimally invasive treatment modality for the management of pancreatic diseases. It is important for the clinician to know the indications and contraindications as well as the timing of various endoscopic interventions. This will help in its safe and effective use and consequently decrease morbidity and mortality from various pancreatic diseases. This review will provide a broad overview of the indications, techniques, and outcomes of pancreatic endotherapy.
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Affiliation(s)
- Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S. Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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6
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Oh CH, Lee JK, Song TJ, Park JS, Lee JM, Son JH, Jang DK, Choi M, Byeon JS, Lee IS, Lee ST, Choi HS, Kim HG, Chun HJ, Park CG, Cho JY. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Clin Endosc 2021; 54:505-521. [PMID: 34305047 PMCID: PMC8357592 DOI: 10.5946/ce.2021.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Kee Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea Seoul ST. Mary's Hospital, Seoul, Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha University Bundang Medical Center, Seongnam, Korea
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7
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Oh CH, Song TJ, Lee JK, Park JS, Lee JM, Son JH, Jang DK, Choi M, Byeon JS, Lee IS, Lee ST, Choi HS, Kim HG, Chun HJ, Park CG, Cho JY. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Gut Liver 2021; 15:677-693. [PMID: 34305047 PMCID: PMC8444102 DOI: 10.5009/gnl210001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/21/2022] Open
Abstract
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to develop medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies. (Gut Liver 2021;15:-693)
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Kore
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Kee Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | | | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, CHA University Bundang Medical Center, Seongnam, Korea
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8
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Rana SS, Dawra S, Sharma R, Kang M, Gupta R. Clinical manifestations, imaging features, and endoscopic management of renal pseudocysts: a case series. Ann Gastroenterol 2020; 33:313-317. [PMID: 32382236 PMCID: PMC7196611 DOI: 10.20524/aog.2020.0476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background Renal pseudocysts (RP) are rare and we know little about their presentation and management. In the present case series, we present the pertinent clinico-radiological features as well as the role of endoscopic drainage in symptomatic RP. Methods A retrospective analysis was performed of patients with RP seen in our unit over the last 12 years. Patient symptoms, imaging findings and details of endoscopic or endoscopic ultrasound (EUS)-guided drainage procedures were evaluated. Results Eight patients with RP (7 male; mean age: 33.1 years) were studied. Seven patients had underlying chronic pancreatitis (calcific in 3), predominantly alcohol-related. The mean size of the RP was 8.5 cm. All patients presented with abdominal pain and none had urinary complaints. The RP could be well detected on both contrast-enhanced computed tomography and EUS. None of the patients had significant debris on EUS. Five patients were treated with combined transmural and transpapillary drainage, 2 patients were treated with transpapillary drainage alone, while combined percutaneous and transpapillary drainage was performed in 1 patient. All patients had partial disruption of the main pancreatic duct and a bridging transpapillary endoprosthesis was successfully placed. The RP resolved in all patients within 2-6 weeks and no patient required surgery. There were no complications and no patient had recurrence of RP over a follow-up period of 3-118 months. Conclusion RP are usually associated with abdominal pain and do not cause renal symptoms. Endoscopic drainage is a safe and effective minimally invasive management option for RP.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology (Surinder Singh Rana, Saurabh Dawra, Ravi Sharma)
| | - Saurabh Dawra
- Department of Gastroenterology (Surinder Singh Rana, Saurabh Dawra, Ravi Sharma)
| | - Ravi Sharma
- Department of Gastroenterology (Surinder Singh Rana, Saurabh Dawra, Ravi Sharma)
| | | | - Rajesh Gupta
- Department of Surgery (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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9
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Kotelnikova LP, Plaksin SA, Farshatova LI. [Mediastinal pancreatic cysts: review and own clinical observations]. Khirurgiia (Mosk) 2019:80-86. [PMID: 31355820 DOI: 10.17116/hirurgia201907180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). MATERIAL AND METHODS There were 5 patients with MPC. RESULTS Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. CONCLUSION MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.
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Affiliation(s)
| | - S A Plaksin
- Vagner Perm State Medical University, Perm, Russia
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10
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Kotb M, Oshiba A, Ashour K. Pseudopancreatic Cyst Extending into the Mediastinum in a 7-Year-Old Child. European J Pediatr Surg Rep 2019; 7:e24-e27. [PMID: 31214482 PMCID: PMC6579729 DOI: 10.1055/s-0039-1688802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/31/2019] [Indexed: 01/23/2023] Open
Abstract
Mediastinal pseudopancreatic cyst (MPP) is the extension of a pancreatic pseudocyst through esophageal or aortic hiatus into the posterior mediastinum. It can produce a range of manifestations caused by compression by the cyst, for instance, odynophagia, dysphagia, pericardial, or pleural effusion. Here we report a case of MPP in a 7-year-old child who was presented with repeated chest infections and left pleural effusion. It was successfully drained by cystogastrostomy.
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Affiliation(s)
- Mostafa Kotb
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Oshiba
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Khaled Ashour
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
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11
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Rana SS, Shah J, Sharma R, Gupta R. Unusual tubular cystic lesion compressing inferior vena cava. JGH OPEN 2019; 3:182-184. [PMID: 31061896 PMCID: PMC6487822 DOI: 10.1002/jgh3.12126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022]
Abstract
Fluid collections are important local complications of acute pancreatitis (AP). They are usually located in peri-pancreatic region but can also be found in various atypical locations like mediastinum, spleen, liver, pelvis or neck. Such pancreatic fluid collections in atypical locations can cause diagnostic dilemma and may cause delay in management. We report an interesting case of AP who presented to us with a walled-off necrosis mimicking a long cystic mass lesion surrounding the IVC.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Jimil Shah
- Department of Gastroenterology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Ravi Sharma
- Department of Gastroenterology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Rajesh Gupta
- Department of Surgery Post Graduate Institute of Medical Education and Research Chandigarh India
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12
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Kumar P, Gupta P, Rana S. Thoracic complications of pancreatitis. JGH OPEN 2018; 3:71-79. [PMID: 30834344 PMCID: PMC6386740 DOI: 10.1002/jgh3.12099] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
Acute pancreatitis in its severe form may lead to systemic inflammatory response syndrome and multisystem organ dysfunction. Acute lung injury is an important cause of mortality in the setting of severe acute pancreatitis. Besides lung involvement, acute and chronic pancreatitis may also lead to the involvement of other thoracic compartments, including mediastinum, pleura, and vascular structures. These manifestations are an important cause of morbidity and may pose diagnostic and therapeutic challenges. These manifestations have not been discussed in detail in the available literature. In this review, we discuss the thoracic complications of pancreatitis, including lung, pleural, mediastinal, and vascular manifestations.
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Affiliation(s)
- Prem Kumar
- Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Pankaj Gupta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Surinder Rana
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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13
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Teoh AYB, Dhir V, Kida M, Yasuda I, Jin ZD, Seo DW, Almadi M, Ang TL, Hara K, Hilmi I, Itoi T, Lakhtakia S, Matsuda K, Pausawasdi N, Puri R, Tang RS, Wang HP, Yang AM, Hawes R, Varadarajulu S, Yasuda K, Ho LKY. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 2018; 67:1209-1228. [PMID: 29463614 DOI: 10.1136/gutjnl-2017-314341] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 12/22/2017] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Interventional endoscopic ultrasonography (EUS) procedures are gaining popularity and the most commonly performed procedures include EUS-guided drainage of pancreatic pseudocyst, EUS-guided biliary drainage, EUS-guided pancreatic duct drainage and EUS-guided celiac plexus ablation. The aim of this paper is to formulate a set of practice guidelines addressing various aspects of the above procedures. METHODS Formulation of the guidelines was based on the best scientific evidence available. The RAND/UCLA appropriateness methodology (RAM) was used. Panellists recruited comprised experts in surgery, interventional EUS, interventional radiology and oncology from 11 countries. Between June 2014 and October 2016, the panellists met in meetings to discuss and vote on the clinical scenarios for each of the interventional EUS procedures in question. RESULTS A total of 15 statements on EUS-guided drainage of pancreatic pseudocyst, 15 statements on EUS-guided biliary drainage, 12 statements on EUS-guided pancreatic duct drainage and 14 statements on EUS-guided celiac plexus ablation were formulated. The statements addressed the indications for the procedures, technical aspects, pre- and post-procedural management, management of complications, and competency and training in the procedures. All statements except one were found to be appropriate. Randomised studies to address clinical questions in a number of aspects of the procedures are urgently required. CONCLUSIONS The current guidelines on interventional EUS procedures are the first published by an endoscopic society. These guidelines provide an in-depth review of the current evidence and standardise the management of the procedures.
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Affiliation(s)
- Anthony Y B Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Mumbai, Maharashtra, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University Hospital, Sagamihara City, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Zhen Dong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Center, Seoul, Republic of Korea
| | - Majid Almadi
- Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ida Hilmi
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Takao Itoi
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Koji Matsuda
- St Marianna University School of Medicine, Yokohama City Seibu Hospital, Kawasaki, Japan
| | - Nonthalee Pausawasdi
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rajesh Puri
- Department of Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta, The Medicity, Gurgaon, India
| | - Raymond S Tang
- Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ai Ming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng-qu, Beijing, China
| | - Robert Hawes
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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Kim HJ, Jun CH, Park CH, Cho CK. Intrahepatic Pancreatic Pseudocyst Complicated by Pancreatitis: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:202-207. [PMID: 29060959 DOI: 10.4166/kjg.2017.70.4.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11x10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.
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Affiliation(s)
- Hee Joon Kim
- Department of Surgery and Division of Gastroenterology, Chonnam National University Medical School, Gwangju, Korea
| | - Chung Hwan Jun
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chol Kyoon Cho
- Department of Surgery and Division of Gastroenterology, Chonnam National University Medical School, Gwangju, Korea
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15
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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16
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Kriger AG, Polyakov IS, Gorin DS, Smirnov AV. [Rare combination of complications of chronic pancreatitis]. Khirurgiia (Mosk) 2017:77-79. [PMID: 28303877 DOI: 10.17116/hirurgia2017277-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - D S Gorin
- Vishnevsky Institute of Surgery, Moscow
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17
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Mediastinal Pseudocyst: Varied Presentations and Management-Experience from a Tertiary Referral Care Centre in India. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2017; 2017:5247626. [PMID: 28392624 PMCID: PMC5368372 DOI: 10.1155/2017/5247626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/01/2017] [Accepted: 02/26/2017] [Indexed: 11/23/2022]
Abstract
Pseudocysts are a recognised complication following acute or chronic pancreatitis. Usually located in peripancreatic areas, they have also been reported to occur in atypical regions like liver, pelvis, spleen, and mediastinum. Mediastinal pseudocysts are a rare entity and present with myriad of symptoms due to their unique location. They are a clinical challenge to diagnose and manage. In this paper, we describe the clinical and radiological characteristics of mediastinal pseudocysts in 7 of our patients, as well as our experience in managing these patients along with their clinical outcome.
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Chhabra P, Rana SS, Sharma V, Bhasin DK. An unusual neck swelling: Extension of mediastinal pseudocyst into the neck. Endosc Ultrasound 2017; 6:71-72. [PMID: 28218206 PMCID: PMC5331849 DOI: 10.4103/2303-9027.200210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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19
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Demeusy A, Hosseini M, Sill AM, Cunningham SC. Intrahepatic pancreatic pseudocyst: A review of the world literature. World J Hepatol 2016; 8:1576-1583. [PMID: 28050239 PMCID: PMC5165272 DOI: 10.4254/wjh.v8.i35.1576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/26/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).
METHODS A literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.
RESULTS We found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).
CONCLUSION Diagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.
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Rana SS, Sharma R, Chhabra P, Sharma V, Gupta R, Bhasin DK. Endoscopic management of splenic pseudocysts associated with acute and chronic pancreatitis. Ann Gastroenterol 2016; 29:373-7. [PMID: 27366041 PMCID: PMC4923826 DOI: 10.20524/aog.2016.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Splenic pseudocysts (SP) are a rare consequence of both acute and chronic pancreatitis. Surgery has been conventional treatment for SP and literature on role of endoscopic treatment is scant. In this study, we retrospectively evaluated SP clinical and radiological characteristics as well as the outcome following endoscopic drainage. Methods Retrospective analysis of SP patients seen at our unit from January 2002 to June 2015. All patients were treated with attempted endoscopic transpapillary drainage with a nasopancreatic drain or stent. Patients not responding underwent endoscopic ultrasound-guided transmural or percutaneous radiological drainage. Results Eleven patients with SP (all male; mean age: 40.5±8.8 years) were studied. Seven patients had chronic pancreatitis and 4 patients had SP following acute pancreatitis. The majority (10/11; 91%) had alcohol-related acute or chronic pancreatitis with one patient having coexistent pancreas divisum. Seven (64%) patients were treated successfully with transpapillary drainage only; one (9%) patient needed combined transpapillary and transmural drainage; and 3 (27%) patients needed surgery. Conclusion Endoscopic transpapillary drainage is an effective treatment for SP especially when it is not infected and with clear contents, and is associated with partial ductal disruption that can be bridged by an endoprosthesis.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Deepak Kumar Bhasin), India
| | - Ravi Sharma
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Deepak Kumar Bhasin), India
| | - Puneet Chhabra
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Deepak Kumar Bhasin), India; Department of Gastroenterology and Hepatology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak Kumar Bhasin), India
| | - Vishal Sharma
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Deepak Kumar Bhasin), India
| | - Rajesh Gupta
- Department of Surgery (Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Deepak Kumar Bhasin), India; Department of Gastroenterology and Hepatology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak Kumar Bhasin), India
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21
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Abstract
Extracorporeal shock wave lithotripsy is recommended as the first-line therapy for large (>5-mm) obstructive pancreatic ductal stones. Dominant pancreatic duct strictures should be initially managed with a wide-bore single plastic stent with 3 monthly exchanges for a year, even in asymptomatic patients. Recent studies have evaluated multiple plastic and self-expanding covered metal stents for refractory pancreatic ductal stricture. Pancreatic pseudocysts should be treated endoscopically with or without endoscopic ultrasound guidance.
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Rana SS, Bhasin DK. Nonfluoroscopic endoscopic ultrasound-guided transmural drainage of pseudocysts: A pictorial technical review. Endosc Ultrasound 2015; 4:92-7. [PMID: 26020042 PMCID: PMC4445182 DOI: 10.4103/2303-9027.156719] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/08/2014] [Indexed: 01/11/2023] Open
Abstract
Pancreatic pseudocysts (PP) are one of the important local complications of pancreatitis and can be treated by surgical, laparoscopic, percutaneous, or endoscopic methods. The endoscopic methods of drainage include transpapillary or transmural drainage or a combination of these two routes. The transmural drainage can be done using conventional duodenoscope without endoscopic ultrasound (EUS) guidance or under EUS guidance. The EUS-guided transmural drainage of PP is done under EUS and fluoroscopic guidance. We have earlier reported nonfluoroscopic EUS-guided transmural drainage of walled-off pancreatic necrosis. In this pictorial technical review, we will discuss in detail this method of nonfluoroscopic EUS-guided drainage of PP.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Karamouzos V, Karavias D, Siagris D, Kalogeropoulou C, Kosmopoulou F, Gogos C, Velissaris D. Pancreatic mediastinal pseudocyst presenting as a posterior mediastinal mass with recurrent pleural effusions: a case report and review of the literature. J Med Case Rep 2015; 9:110. [PMID: 25962880 PMCID: PMC4481071 DOI: 10.1186/s13256-015-0582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/30/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction A rare complication of chronic pancreatitis is the formation of single or multiple mediastinal pseudocysts, which are fueled from the pancreas through anatomical openings of the diaphragm. We present a rare case with a difficult diagnosis, treatment and potentially catastrophic complications. Case presentation A 53-year-old Caucasian man was referred to our hospital for further investigation and treatment of a large heterogeneous mass situated in the posterior mediastinum, and bilateral pleural effusions which had developed after recent multiple episodes of pancreatitis. He had a history of chronic alcoholism. Laboratory and imaging modalities established the diagnosis of a pancreatic mediastinal pseudocyst. Conclusions Despite successful initial conservative treatment, our patient had a relapse and underwent emergency surgical intervention due to internal hemorrhage. We present his diagnostic and imaging workup, along with the multidisciplinary intervention, and a literature review referring to the diagnosis and treatment of mediastinal pancreatic pseudocysts.
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Affiliation(s)
- Vasilis Karamouzos
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Karavias
- General Surgery Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Siagris
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | | | - Fay Kosmopoulou
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Charalampos Gogos
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Velissaris
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
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24
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Aswani Y, Anandpara KM, Hira P. Page kidney due to a renal pseudocyst in a setting of pancreatitis. BMJ Case Rep 2015; 2015:bcr-2014-207436. [PMID: 25618881 DOI: 10.1136/bcr-2014-207436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pancreatic pseudocysts are notorious for their extension beyond the normal confines of the pancreatic bed due to dissection of the enzymatic pseudocyst fluid along fascial planes. Such collections of pancreatic juice may compress the kidney. Extension of the pseudocyst into the perirenal space is, however, uncommon. We report a case of pseudocyst of pancreas lying in the subcapsular plane of the left kidney with a patent communication with the pancreatic duct (pancreaticorenal fistula). The compressive effect of the pseudocyst on the kidney compromised intrarenal perfusion as evidenced by a faint nephrogram but a normal renal artery. This led to renin-angiotensin-aldosterone mediated hypertension-the Page kidney phenomenon. Extensive literature search revealed our case to be the only one to describe such an occurrence.
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Affiliation(s)
- Yashant Aswani
- Seth G S Medical College and KEM Hospital, Mumbai, India
| | | | - Priya Hira
- Seth G S Medical College and KEM Hospital, Mumbai, India
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25
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Rana SS, Bhasin DK, Rao C, Gupta R. Intramural pseudocysts of the upper gastrointestinal tract. Endosc Ultrasound 2014; 2:194-8. [PMID: 24949395 PMCID: PMC4062274 DOI: 10.4103/2303-9027.121240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/04/2013] [Indexed: 12/30/2022] Open
Abstract
Background: Intramural pseudocysts or pseudocysts occurring in the gastrointestinal tract (GIT) wall are rare and there is a paucity of data on their clinical features and management. Patients and Methods: We retrospectively evaluated patients with intramural pseudocysts seen at our institution over the past 6 years. Intramural location was confirmed either on surgery or endoscopic ultrasound (EUS). Depending upon the symptoms, their control with the conservative medical therapy and procedural consent, the patients underwent EUS guided single time aspiration of the pseudocyst or transmural drainage or transpapillary drainage or surgery. Results: A total of 9 patients with intra mural pseudocysts (male: n = 8; mean age ± SD: 39.3 ± 8.0 years; age range: 24-54 years; five patients having chronic and four patients having acute pancreatitis) were studied. The pseudocysts were located in the wall of the second part of the duodenum in five patients, in the gastric wall in three patients and in the lower esophageal wall in one patient. The size of the pseudocysts ranged from 8 mm to 8 cm and 3/9 (33%) patients had associated extra mural pancreatic pseudocysts. All patients had abdominal pain on presentation. Along with pain the patients with duodenal intramural pseduocysts also had symptoms suggestive of gastric outlet obstruction (3) or jaundice (1). The patient with esophageal intramural pseudocyst had dysphagia along with abdominal pain. Majority of these patients could be successfully treated endoscopically with no significant complications. Conclusions: Intramural pseudocysts of the upper GIT are very rare and EUS is a useful investigational modality for diagnosing and treating them.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chalapathi Rao
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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26
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Rana SS, Chaudhary V, Sharma V, Sharma R, Dutta U, Bhasin DK. Infected pancreatic pseudocyst of spleen successfully treated by combined endoscopic transpapillary stent placement and transmural aspiration. Gastrointest Endosc 2014; 79:360-1. [PMID: 24433634 DOI: 10.1016/j.gie.2013.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/03/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinita Chaudhary
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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27
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Prognostic factors for successful endoscopic transpapillary drainage of pancreatic pseudocysts. Dig Dis Sci 2014; 59:459-64. [PMID: 24185684 DOI: 10.1007/s10620-013-2924-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 08/23/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The transpapillary approach can be used for draining pancreatic pseudocysts (PPs) with pancreatic-duct abnormalities. The purpose of this study was to analyze prognostic factors for clinical success of transpapillary drainage. PATIENTS AND METHODS Data for all patients who underwent transpapillary drainage between November 2000 and September 2009 were obtained by retrospective review and entered into a computerized database. Patient data were prospectively followed up to determine long-term outcomes. RESULTS Seventy interventional ERCP procedures were performed for 43 patients. Technical success was 90.7 % (39/43). Overall clinical success was 79.5 % (31/39). Clinical success for pancreatic head pseudocyst was significantly different from that for body or tail pseudocyst (62.5 vs. 91.3 %, P = 0.043). Logistic regression analysis showed that location of the PPs predicted the success of endoscopic transpapillary pseudocyst drainage (P = 0.025). CONCLUSION Transpapillary drainage is the least traumatic approach for drainage of PPs, and is also effective for patients with no communicating pseudocysts. Clinical success for pancreatic body or tail pseudocyst drainage was higher than that for pancreatic head pseudocyst drainage. It was found that the location of PPs predicted the success of transpapillary pseudocyst drainage. None of the other factors tested was a significant predictor of clinical success.
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28
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Varadarajulu S, Rana SS, Bhasin DK. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am 2013; 23:863-92. [PMID: 24079795 DOI: 10.1016/j.giec.2013.06.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pancreatitis, whether acute or chronic, can lead to a plethora of complications, such as fluid collections, pseudocysts, fistulas, and necrosis, all of which are secondary to leakage of secretions from the pancreatic ductal system. Partial and side branch duct disruptions can be managed successfully by transpapillary pancreatic duct stent placement, whereas patients with disconnected pancreatic duct syndrome require more complex endoscopic interventions or multidisciplinary care for optimal treatment outcomes. This review discusses the current status of endoscopic management of pancreatic duct leaks and emerging concepts for the treatment of disconnected pancreatic duct syndrome.
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Affiliation(s)
- Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA.
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29
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Bhasin DK, Rana SS, Sharma V, Rao C, Gupta V, Gupta R, Kang M, Singh K. Non-surgical management of pancreatic pseudocysts associated with arterial pseudoaneurysm. Pancreatology 2013; 13:250-3. [PMID: 23719596 DOI: 10.1016/j.pan.2013.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pseudoaneurysms associated with pancreatic pseudocysts are different from simple, isolated pancreatic pseudoaneurysms and there is paucity of published data on their non surgical treatment. AIM To retrospectively analyze results of combination of angioembolisation or thrombin injection followed by endoscopic transpapillary drainage for management of pseudoaneurysms associated with pancreatic pseudocysts. METHODS Eight patients (all males; mean age ± SD: 31.2 ± 6.1 years; age range: 21-38 years) underwent radiological management of the pseudoaneurysm followed by endoscopic drainage of the pseudocysts. RESULTS All patients had pseudocysts (median size 4 cm) with underlying chronic pancreatitis. All patients had abdominal pain on presentation and 7/8 (87.5%) patients had presented with overt gastrointestinal bleeding. The size of the pseudoaneurysms varied from 1 to 4 cm. Two patients were treated with percutaneous thrombin injection whereas six patients underwent digital subtraction angiography and angioembolisation. All patients underwent successful endoscopic transpapillary drainage through the major (5) or minor papilla (3) and resolution of pseudocysts was noted within 6 weeks (median 4 weeks). No significant complication of the procedure was noted in any of the patients. CONCLUSIONS Pseudoaneurysms associated with pancreatic pseudocysts can be successfully and safely treated with a combination of radiological obliteration of the pseudoaneurysm followed by endoscopic transpapillary drainage.
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Affiliation(s)
- Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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30
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Bhasin DK, Rana SS, Rao C, Gupta R, Kang M, Sinha SK, Nagi B, Singh K. Clinical presentation, radiological features, and endoscopic management of mediastinal pseudocysts: experience of a decade. Gastrointest Endosc 2012; 76:1056-60. [PMID: 22867447 DOI: 10.1016/j.gie.2012.06.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/18/2012] [Indexed: 02/08/2023]
Affiliation(s)
- Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
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31
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Seewald S, Ang TL, Richter H, Teng KYK, Zhong Y, Groth S, Omar S, Soehendra N. Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections. Dig Endosc 2012; 24:36-41. [PMID: 22211410 DOI: 10.1111/j.1443-1661.2011.01162.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. METHODS The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively. RESULTS Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%). CONCLUSIONS Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.
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Affiliation(s)
- Stefan Seewald
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland.
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32
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Comparative evaluation of transpapillary drainage with nasopancreatic drain and stent in patients with large pseudocysts located near tail of pancreas. J Gastrointest Surg 2011; 15:772-6. [PMID: 21359595 DOI: 10.1007/s11605-011-1466-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 02/08/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic transpapillary drainage is usually not advocated for large pseudocysts for fear of infection. We compared efficacy of transpapillary drainage with nasopancreatic drain (NPD) or stent alone in large pseudocysts (>6 cm) located near tail of pancreas. METHODS In a prospective study, a 5-Fr stent/NPD was placed across/near pancreatic duct disruption in 11 patients (nine chronic and two acute pancreatitis) with large pseudocysts located near tail of pancreas. The patients were followed up for resolution of pseudocyst, need for surgery, and complications. RESULTS Pseudocysts diameter ranged from 7 to 15 cm. An attempt to place NPD was made in five patients and a stent in six patients. In NPD group, deep cannulation could not be achieved in one patient; it was treated successfully with percutaneous drainage. In four patients with partial duct disruption, NPD was successfully placed bridging disruption and all had resolution within 6 weeks. In stent group, five had partial and one had complete duct disruption, who later recovered by placement of a stent. Of five patients with partial disruption, one recovered uneventfully at 6 weeks with stent bridging disruption. Other four patients (bridging stent in three) developed febrile illness and infection of pseudocyst. They required additional percutaneous drainage and antibiotics. There was no recurrence of pseudocysts over follow-up of 16.4 months. CONCLUSION Endoscopic transpapillary drainage with NPD bridging disruption is associated with good outcome in patients with large pseudocysts at tail end of pancreas. However, there was increased frequency of infection when stent was used for drainage.
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