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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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Lee AY, Amaral AC, Han S. Endosonographic visualization of a mediastinal pancreatic pseudocyst. Endoscopy 2022; 55:E214-E215. [PMID: 36400044 PMCID: PMC9829967 DOI: 10.1055/a-1966-0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Alexander Y. Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anna Cecilia Amaral
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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3
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Velasquez-Rodriguez JG, Maisterra S, Ramos R, Escobar I, Gornals JB. The Role of Endoscopic Ultrasound in the Interventional Management of Mediastinal Collections: A Narrative Review. Cureus 2022; 14:e27803. [PMID: 36106250 PMCID: PMC9452048 DOI: 10.7759/cureus.27803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections.
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4
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Dolzhanskij OV, Gurevich LE, Bazarov DV. [Mature teratoma of the anterior mediastinum with a predominance of the pancreatic component and signs of focal nesidioblastosis]. Arkh Patol 2022; 84:52-59. [PMID: 35639844 DOI: 10.17116/patol20228403152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of a mature anterior mediastinal teratoma with a predominance of the pancreatic component (80% of the tumor) and signs of nesidioblastosis in a 46-year-old woman is presented. During histological examination, all components of the pancreatic parenchyma were determined - acini with interlobular and intralobular ducts, endocrine cells and islets of Langerhans of various sizes and shapes, as well as islet-duct complexes scattered in the acinar tissue. In addition to pancreatic tissue, cartilage, bronchial respiratory epithelium, small intestine tissue, hair follicles, and sebaceous glands were found in the neoplasm. Immunohistochemical examination revealed signs of focal nesidioblastosis. In the islets, insulin-positive β-cells (80.0% of the volume of the islets), as well as endocrine cells expressing glucagon and somatostatin (10.0% of the volume of the islets) were determined. By 2020, only 4 such cases have been published in the English-language literature.
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Affiliation(s)
- O V Dolzhanskij
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - L E Gurevich
- Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - D V Bazarov
- B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia
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5
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Liao Y, Chiu N, Chen C, Su K. Acute‐on‐chronic pancreatitis complicated with mediastinal pseudocysts and cardiac tamponade: A case report and literature review. Respirol Case Rep 2022; 10:e0929. [PMID: 35309959 PMCID: PMC8907752 DOI: 10.1002/rcr2.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/08/2022] Open
Abstract
The clinical course and severity of pancreatitis might vary largely. Pancreatitis‐related thoracic complications might be life‐threatening but frequently ignored. We report an alcoholic patient who initially presented to the emergency department with community‐acquired pneumonia, acute respiratory failure and acute‐on‐chronic pancreatitis with massive pancreatic pleural effusion. Subsequently, he developed insidiously pancreatitis‐related intra‐abdominal, mediastinal pseudocysts, and unexpectedly sudden onset of cardiac tamponade. Although tamponade‐related haemodynamic instability improved soon after timely diagnosis and emergent pericardial drainage, his recovery period was prolonged. His serum amylase and lipase were persistently elevated until definitive treatment with endoscopic retrograde cholangiopancreatography‐assisted removal of pancreatic duct stones. Pancreatitis‐related cardiac tamponade is rare but lethal without prompt diagnosis and management. We reviewed pancreatitis‐related thoracic complications, particularly for cardiac tamponade, and discussed about the pathophysiology and management options.
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Affiliation(s)
- Ying‐Ting Liao
- Department of Chest Medicine Taipei Veterans General Hospital Taipei City Taiwan, Republic of China
| | - Nai‐Chi Chiu
- Department of Radiology Taipei Veterans General Hospital Taipei City Taiwan, Republic of China
- School of Medicine National Yang Ming Chiao Tung University, Yangming Campus Taipei City Taiwan, Republic of China
| | - Chun‐Ku Chen
- Department of Radiology Taipei Veterans General Hospital Taipei City Taiwan, Republic of China
- School of Medicine National Yang Ming Chiao Tung University, Yangming Campus Taipei City Taiwan, Republic of China
| | - Kang‐Cheng Su
- Department of Chest Medicine Taipei Veterans General Hospital Taipei City Taiwan, Republic of China
- School of Medicine National Yang Ming Chiao Tung University, Yangming Campus Taipei City Taiwan, Republic of China
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6
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Rana SS, Kang M, Bush N, Gupta R. Pneumomediastinum after Endoscopic Transmural Drainage of an Acute Pseudocyst: Not All That Scary! JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0041-1741065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Kang
- Department of Radiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikhil Bush
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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7
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Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis. Case Rep Radiol 2021; 2021:1919550. [PMID: 34888110 PMCID: PMC8651394 DOI: 10.1155/2021/1919550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.
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8
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Johnson TA, Vinayak A, Heo JY, Green TA. Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review. J Am Anim Hosp Assoc 2021; 58:96-104. [PMID: 34606594 DOI: 10.5326/jaaha-ms-6992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/11/2022]
Abstract
A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.
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9
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Clark HL, Illipparambil LC, Khurana S. Mediastinal pancreatic pseudocyst masquerading as diffuse alveolar haemorrhage. BMJ Case Rep 2021; 14:14/7/e240677. [PMID: 34210696 DOI: 10.1136/bcr-2020-240677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pancreatic pseudocyst formation with extension into the mediastinum is an uncommon complication of pancreatitis that can result in numerous pulmonary and cardiac complications. We present a case of a 56-year-old man with a history of recurrent pancreatitis who presented with haemoptysis. His initial workup was consistent with diffuse alveolar haemorrhage for which he was treated with glucocorticoids. After failure to improve, further imaging demonstrated a complex fluid collection in the mediastinum consistent with extension of his pre-existing pancreatic pseudocyst, leading to erosion into the right lower lobe of the lung. This case highlights a rare pulmonary complication of pancreatitis and underscores the importance of proper identification of this condition to guide successful management.
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Affiliation(s)
- Heather Lynn Clark
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Lijo C Illipparambil
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sandhya Khurana
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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10
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Park JW, Jeong WG, Lee JE, Lee HJ, Ki SY, Lee BC, Kim HO, Kim SK, Heo SH, Lim HS, Shin SS, Yoon W, Jeong YY, Kim YH. Pictorial Review of Mediastinal Masses with an Emphasis on Magnetic Resonance Imaging. Korean J Radiol 2020; 22:139-154. [PMID: 32783412 PMCID: PMC7772375 DOI: 10.3348/kjr.2019.0897] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.
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Affiliation(s)
- Jin Wang Park
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyo Jae Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - So Yeon Ki
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yun Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
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11
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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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12
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Chan YM, Huang WH. Fist-Sized Radiographic Consolidation in a Man With Difficulty Swallowing. Gastroenterology 2019; 157:e6-e7. [PMID: 31078620 DOI: 10.1053/j.gastro.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Yi-Ming Chan
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Hsin Huang
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
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13
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Panchal R, Carter KT, Shepherd B, De Delva P, Koller F, Copeland H. Mediastinal Pancreatic Pseudocyst: A Rare Cause of New Onset Dysphagia. Am Surg 2019. [DOI: 10.1177/000313481908500813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ramola Panchal
- Department of Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Kristen T. Carter
- Department of Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Benjamin Shepherd
- Department of Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Pierre De Delva
- Division of Cardiothoracic Surgery Department of Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Felicitas Koller
- Division of Transplant and Hepatobiliary Surgery Department of Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Hannah Copeland
- Department of Surgery University of Mississippi Medical Center Jackson, Mississippi
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14
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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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15
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Omer A, Engelman E, McClain J. Mediastinal extension of a pancreatic pseudocyst. Radiol Case Rep 2018; 13:1192-1194. [PMID: 30233758 PMCID: PMC6140621 DOI: 10.1016/j.radcr.2018.08.016] [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] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 11/08/2022] Open
Abstract
A 50-year-old man with a history of chronic pancreatitis due to alcoholism presented with dyspnea, at which time he was diagnosed with pleural effusions, treated, and discharged. Two months later, he was readmitted with hemoptysis and abdominal pain. CT and MRI of the chest demonstrated a mediastinal cystic mass that communicated with the retroperitoneum. Ultrasound-guided aspiration of the cystic mass revealed high levels of amylase, confirming that the mass was a rare pancreatic pseudocyst extending into the mediastinum.
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Affiliation(s)
- Adil Omer
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH, USA
| | - Ester Engelman
- Department of Radiology, NYC Health + Hospitals/Harlem, New York, NY, USA
| | - Justin McClain
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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16
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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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17
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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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18
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[Unclear dysphagia]. Chirurg 2015; 87:438-40. [PMID: 26341196 DOI: 10.1007/s00104-015-0080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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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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Brahmbhatt P, McKinney J, Litchfield J, Panchal M, Borthwick T, Young M, Klosterman L. Mediastinal pancreatic pseudocyst with hemorrhage and left gastric artery pseudoaneurysm, managed with left gastric artery embolization and placement of percutaneous trans-hepatic pseudocyst drainage. Gastroenterol Rep (Oxf) 2014; 4:241-5. [PMID: 25502760 PMCID: PMC4976671 DOI: 10.1093/gastro/gou084] [Citation(s) in RCA: 7] [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: 09/15/2014] [Accepted: 10/13/2014] [Indexed: 01/09/2023] Open
Abstract
Mediastinal pancreatic pseudocyst (MPP) is a rare, but known, complication of both acute and chronic pancreatitis. Most pseudocysts are associated with alcoholic pancreatitis. Recent advances in endoscopic techniques have shown promising results, with reduced chances of infection and recurrence than with percutaneous drainage, but limited availability restricts widespread use. Left gastric artery pseudoaneurysm with mediastinal pseudocyst has not been described in the literature to date. We report a successful resolution of hemorrhagic MPP with embolization of pseudoaneurysm and percutaneous trans-hepatic pseudocyst drainage.
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Affiliation(s)
- Parag Brahmbhatt
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA,
| | - Jason McKinney
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA
| | - John Litchfield
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA
| | - Mehul Panchal
- Department of Medicine, M. P. Shah Medical College, Jamnagar, Gujarat, India
| | - Thomas Borthwick
- Department of Gastroenterology, James H. Quillen VA Medical Center, Johnson City, TN, USA and
| | - Mark Young
- Division of Gastroenterology and Hepatology, East Tennessee State University, Johnson City, TN, USA
| | - Lance Klosterman
- Department of Radiology, James H. Quillen VA Medical center, Johnson City, TN, USA
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21
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Li WW, van Boven WJ, Jurhill RR, Bonta PI, Annema JT, de Mol BA. Ectopic pancreas in a giant mediastinal cyst. CLINICAL RESPIRATORY JOURNAL 2014; 10:125-8. [DOI: 10.1111/crj.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/25/2014] [Accepted: 06/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Wilson W. Li
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
| | - Wim Jan van Boven
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
| | - Roy R. Jurhill
- Department of Pathology; University of Amsterdam; Amsterdam the Netherlands
| | - Peter I. Bonta
- Department of Respiratory Medicine, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Jouke T. Annema
- Department of Respiratory Medicine, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Bas A. de Mol
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
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Chaudhary V, Rana SS, Sharma V, Sharma AR, Nada R, Gupta R, Dutta U, Singh K, Bhasin DK. Esophageal duplication cyst in an adult masquerading as submucosal tumor. Endosc Ultrasound 2014; 2:165-7. [PMID: 24949388 PMCID: PMC4062263 DOI: 10.7178/eus.06.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/21/2013] [Indexed: 01/05/2023] Open
Abstract
Gastrointestinal duplications usually manifest in children and may involve the esophagus in 20% cases. Esophageal duplication cysts are a rare cause of dysphagia in adults. We report the case of a 35-year-old male who presented to us with progressive dysphagia of 6 months duration. Contrast enhanced computed tomography showed a soft-tissue lesion in right lateral wall of distal thoracic esophagus. On endoscopic ultrasound, a heterogeneously echotextured lesion with anechoic component present at intramural location in the lower esophagus was noted. The patient underwent surgical excision of the lesion and histopathology confirmed the diagnosis of esophageal duplication cyst.
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Affiliation(s)
- Vinita Chaudhary
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- 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
| | - Amit Raj Sharma
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, 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
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kartar Singh
- 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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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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Barrueco-Francioni J, Mora J, Olea V. Mediastinal and base of skull pancreatic pseudocyst. Pancreatology 2014; 14:143. [PMID: 24795917 DOI: 10.1016/j.pan.2013.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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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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