1
|
Koo JGA, Liau MYQ, Kryvoruchko IA, Habeeb TAAM, Chia C, Shelat VG. Pancreatic pseudocyst: The past, the present, and the future. World J Gastrointest Surg 2024; 16:1986-2002. [PMID: 39087130 PMCID: PMC11287700 DOI: 10.4240/wjgs.v16.i7.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 07/22/2024] Open
Abstract
A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.
Collapse
Affiliation(s)
- Jonathan GA Koo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Igor A Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv 61022, Ukraine
| | - Tamer AAM Habeeb
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Christopher Chia
- Department of Gastroenterology, Woodlands General Hospital, Singapore 737628, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| |
Collapse
|
2
|
Zeng Y, Yang J, Zhang JW. Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges. World J Clin Cases 2023; 11:1888-1902. [PMID: 36998953 PMCID: PMC10044952 DOI: 10.12998/wjcc.v11.i9.1888] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
Infected necrotizing pancreatitis (INP) represents a severe condition in patients with acute pancreatitis. Invasive interventions are recommended in symptomatic INP. Growing evidence has suggested interventional strategies of INP evolving from traditional surgery to minimally invasive step-up endoscopic procedures. However, there is still no standardized protocol for endoscopic interventions. Recently, various studies have been published about the endoscopic management of INP. This article reviews published articles and guidelines to present the progress and challenges of endoscopic transluminal drainage and necrosectomy in INP.
Collapse
Affiliation(s)
- Yan Zeng
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jian Yang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
3
|
Bhakta D, de Latour R, Khanna L. Management of pancreatic fluid collections. Transl Gastroenterol Hepatol 2022; 7:17. [PMID: 35548474 PMCID: PMC9081921 DOI: 10.21037/tgh-2020-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2023] Open
Abstract
Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).
Collapse
Affiliation(s)
- Dimpal Bhakta
- New York University School of Medicine, New York, USA
| | | | - Lauren Khanna
- New York University School of Medicine, New York, USA
| |
Collapse
|
4
|
Non-pancreatic pseudo cyst of oral cavity-case report. Int J Surg Case Rep 2021; 90:106639. [PMID: 34902702 PMCID: PMC8666636 DOI: 10.1016/j.ijscr.2021.106639] [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: 10/17/2021] [Revised: 11/22/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Cyst is commonly found in oral and maxillofacial region, but non-pancreatic pseudo cyst in this region is quite rare. None of the such cases have been reported so far. Presented here is the case of non-pancreatic pseudo cyst in the right cheek. A description and management of this pathology through open surgery is given, while preserving the anatomy of the cheek. Case presentation The authors report a non-pancreatic pseudo cyst of the right cheek in a 4 years old boy. His parents noticed swelling over right cheek which slowly increases in size without any other associated symptoms. The swelling was firm, non-tender, nonfluctuant, non-pulsatile, margin was distinct, overlying mucosa was normal in colour, aspiration was negative, 3x2x1 cc in size. The surgical excision of the tumour was performed through an intraoral approach under general anaesthesia. Intraoperatively we found clotted blood confined within fibrous capsule. During one year postoperative follow-up there was no sign of recurrence. Clinical discussion Pancreatic pseudocysts are benign soft tissue lesion occurring most commonly in pancreas. They are rarely encountered in the soft tissue of Oral and Maxillofacial region. It is the first case of non-pancreatic pseudocyst found in soft tissue of oral and maxillofacial region. The etiopathogenesis of these pseudocysts is not known yet. It may be considered as soft tissue counterpart of Aneurysmal Bone Cyst (ABC). Conclusion Non pancreatic pseudo cysts may form in soft tissue of oral and maxillofacial region. Non pancreatic pseudo cyst in soft tissue of oral and maxillofacial region is not documented anywhere yet. Its rare case report. This non pancreatic pseudocyst in right cheek consists of clotted blood confined within fibrous connective tissue. Histologically it resembles the pseudocyst of pancreas. In one year follow up there was no sign of recurrence.
Collapse
|
5
|
Pancreatic Disorders of Pregnancy. Clin Obstet Gynecol 2021; 63:226-242. [PMID: 31789887 DOI: 10.1097/grf.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The pancreas is an organ with both exocrine and endocrine functions that has a vital role in both digestion as well as glucose metabolism. Although pancreatic dysfunction and disorders are rare in pregnancy, they are becoming increasingly more common. Recognition of these disorders and understanding how they can affect pregnancy is imperative to allow for proper management. We provide an overview of the most common pancreatic disorders that are seen in pregnancy.
Collapse
|
6
|
Bassi M, Desai A, Pitchumoni C. Recurrent Large Bowel Obstruction Caused by Necrotizing Pancreatitis: A Rare Manifestation. Cureus 2020; 12:e12307. [PMID: 33520506 PMCID: PMC7834550 DOI: 10.7759/cureus.12307] [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] [Indexed: 12/04/2022] Open
Abstract
Mechanical obstruction of the colon is rare with necrotizing pancreatitis but is associated with high morbidity and mortality. However, pancreatic ileus, colonic necrosis, and pancreatic colonic fistulae with necrotizing pancreatitis are well known. The anatomic proximity of the pancreas to the transverse colon becomes clinically relevant when a patient with pancreatitis demonstrates a localized ileus of the transverse colon (an old term “the colon cut-off sign”), even when the disease is mild, or lower gastrointestinal bleeding secondary to necrosis of the segment in severe acute pancreatitis. We present the case of a 25-year-old female with choledocholithiasis who presented with severe abdominal pain and was found to have recurrent large bowel obstruction secondary to walled-off pancreatic necrosis. Bowel obstruction is a rare complication of walled-off necrosis, but clinicians should be aware of it due to significantly increased mortality rates. Recurrent bowel obstructions are rarely known in necrotizing pancreatitis and may warrant a bowel resection either electively or acutely. Walled-off necrosis does not respond to typical treatment of symptomatic pseudocysts, which includes endoscopic cystogastrostomy or percutaneous drainage with small-bore catheters. Endoscopic or surgical necrosectomy is necessary for the resolution of walled-off necrosis to evacuate the non-liquefied components.
Collapse
|
7
|
Giant pseudocyst of the pancreas: A report of three cases. Int J Surg Case Rep 2020; 77:284-297. [PMID: 33190104 PMCID: PMC7672251 DOI: 10.1016/j.ijscr.2020.10.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023] Open
Abstract
Giant pseudocysts of pancreas may not be as rare as they were thought to be. They can be effectively managed by cysto-gastrostomy. Gastroscopy is a useful tool for follow up.
Background A Pancreatic pseudocyst is usually a complication of pancreatitis but may follow abdominal trauma in children. Giant pseudocysts are rare and usually complicate chronic pancreatitis. Aim To report 3 cases of giant pseudocysts of the pancreas managed in our Centre within a three-month-period. Case reports Two female patients aged 22 years and 65 years respectively, and an 11-year-old boy presented with giant pancreatic pseudocysts (>10 cm in diameter each) to our unit and were successfully managed. They all underwent exploratory laparotomy and cysto-gastrostomy with good outcome. Conclusion Giant pseudocysts of pancreas may not be as rare as they were thought to be. They can be effectively managed by cysto-gastrostomy
Collapse
|
8
|
Mechanical Duodenal Perforation Due to Complications of Pancreatic Pseudocysts. REPORTS 2020. [DOI: 10.3390/reports3020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pancreatic pseudocysts are a known complication of pancreatitis. There are a multitude of complications which have been described in relation to pancreatic pseudocysts. Perforation of a gastrointestinal hollow viscus is rare but has previously been reported. We report a case of a 72-year-old female with the development of three pancreatic pseudocysts four weeks post gallstone pancreatitis. The patient deteriorated and was found to have a duodenal perforation due to compression forces from the underlying pseudocysts. The patient required emergency surgical intervention and recovered fully following hospital admission.
Collapse
|
9
|
Bansal A, Gupta P, Singh H, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U, Kochhar R. Gastrointestinal complications in acute and chronic pancreatitis. JGH OPEN 2019; 3:450-455. [PMID: 31832543 PMCID: PMC6891019 DOI: 10.1002/jgh3.12185] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 03/21/2019] [Indexed: 01/09/2023]
Abstract
Pancreatitis is one of the important medical conditions. Gastrointestinal (GI) complications of pancreatitis are important and lead to significant morbidity and mortality. Diagnosis of these complications is difficult and may require a strong clinical suspicion coupled with various imaging features. This review provides an extensive update of the whole spectrum of GI complication of pancreatitis, both acute and chronic, from inflammation, ischemia, and necrosis to obstruction, perforation, and GI fistulae. The focus is on the clinical and imaging features of this less commonly described aspect of pancreatitis.
Collapse
Affiliation(s)
- Akash Bansal
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Pankaj Gupta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Harjeet Singh
- Department of Surgery Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Jayanta Samanta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Harshal Mandavdhare
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Vishal Sharma
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Saroj K Sinha
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Usha Dutta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Rakesh Kochhar
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| |
Collapse
|
10
|
Hui D, Hutchinson C, Maine R, Raff L. A Case of Spontaneous Intraperitoneal Rupture of an Acute Necrotic Fluid Collection Associated with Necrotizing Pancreatitis. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:459-464. [PMID: 30951519 PMCID: PMC6463786 DOI: 10.12659/ajcr.914571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 61 Final Diagnosis: Intraperitoneal rupture of acute necrotic peri-pancreatic fluid collection Symptoms: Abdominal and/or epigastric pain • abdominal distension • hypotension • shock Medication: — Clinical Procedure: Exploratory laparotomy with external pancreatic drainage • exploratory laparotomy, cholecystectomy, cystgastrostomy Specialty: Surgery
Collapse
Affiliation(s)
- Donovan Hui
- Department of Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Chelsea Hutchinson
- Department of Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Rebecca Maine
- Department of Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Lauren Raff
- Department of Surgery, University of North Carolina Medical Center, Chapel Hill, NC, USA
| |
Collapse
|
11
|
Patel S, Marshak J, Daum F, Iqbal S. The emerging role of endoscopic ultrasound for pancreaticobiliary diseases in the pediatric population. World J Pediatr 2017; 13:300-306. [PMID: 28393319 DOI: 10.1007/s12519-017-0020-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is a useful diagnostic and therapeutic tool in the pediatric population. Given the high accuracy and sensitivity of EUS, it is particularly effective in evaluating pancreaticobiliary disease. Published literature in the use of pediatric EUS is limited. Therefore we aimed to review the current literature for EUS indications, safety, and effectiveness for the pediatric population. DATA SOURCES English language articles on the use of pediatric endoscopic ultrasound in evaluating pancreaticobiliary diseases were retrieved from PubMed/ MEDLINE. RESULTS We analyzed various retrospective studies and case series publications. Data were extrapolated for pediatric patients with pancreaticobiliary diseases. CONCLUSIONS EUS offers superior imaging. It is comparible to magnetic resonance imaging and/or pancreatic-protocol computed tomography. In the current literature, there are a variety of pancreaticobiliary conditions where EUS was utilized to make a diagnosis. These include recurrent pancreatitis, congenital anomalies, microlithiasis, pancreatic pseudocysts, and pancreatic mass lesions. EUS was shown to be a safe and cost-effective modality with both diagnostic and therapeutic capabilities in the pediatric population. EUS is now increasingly being recognized as a standard of care when evaluating pancreaticobiliary conditions in children.
Collapse
Affiliation(s)
- Suril Patel
- Department of Internal Medicine, Winthrop University Hospital, 180 Hilton Ave, Apt #D1, Hempstead, NY, 11550, USA.
| | - Jarred Marshak
- Department of Internal Medicine, Winthrop University Hospital, 180 Hilton Ave, Apt #D1, Hempstead, NY, 11550, USA
| | - Fredric Daum
- Department of Pediatrics, Winthrop University Hospital, Hempstead, NY, USA
| | - Shahzad Iqbal
- Department of Internal Medicine, Winthrop University Hospital, 180 Hilton Ave, Apt #D1, Hempstead, NY, 11550, USA
| |
Collapse
|
12
|
Abstract
We herein present a patient with a history of heavy alcohol abuse who developed pseudocyst Pancreas and delirium, who came to our hospital for treatment. The patient recovered well with treatment.
Collapse
Affiliation(s)
- Gurvinder Pal Singh
- Department of Psychiatry, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| |
Collapse
|
13
|
Management of Post-Traumatic Complications by Interventional Ultrasound: a Review. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0057-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
14
|
Li Q, Zhu B, Zhu X, Piao C, Cui W, Wang Y, Sun J, Chen W, Miao L. Treatment of necrotizing acute pancreatitis with peritoneal lavage and dialysis by a new simplified technique insert catheters: One retrospective study. Medicine (Baltimore) 2016; 95:e3821. [PMID: 27281083 PMCID: PMC4907661 DOI: 10.1097/md.0000000000003821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Peritoneal lavage and dialysis is an approach to treat necrotizing acute pancreatitis as it removes dialyzable toxins and reduces severe metabolic disturbances. Successful catheter implantation is important for delivering adequate peritoneal lavage and dialysis. The aim of the present study was to describe a new modified percutaneous technique for the placement of peritoneal dialysis catheters and assess the effectiveness and safety of peritoneal lavage and dialysis used for treatment of necrotizing acute pancreatitis. We conducted a retrospective data review of 35 patients of necrotizing acute pancreatitis from January 2010 to December 2014 in Jilin City Central Hospital and The First Affiliated Hospital of ZheJiang University. In total, 18 patients underwent peritoneal lavage and dialysis after inserting catheters by our new technique (group A), whereas 17 patients underwent ultrasound-guided percutaneous catheter drainage (group B). By analyzing the patients' data, the drainage days and mean number of hours between the debut of the symptoms and the hospital admission were lower in group A (P < 0.05, P < 0.05, respectively). The complication rate of 5.6 and 17.6%, respectively (P = 0.261), and a mortality rate of 16.7 and 5.9% for each group, respectively (P = 0.316). Likewise, hospitalization time was similar for the group A: 31 ± 25.3 days compared with 42.8 ± 29.4 days in the group B (P = 0.211). Peritoneal lavage and dialysis can be used in necrotizing acute pancreatitis, and our new modified percutaneous technique offers the same complication and mortality rate as ultrasound-guided drainage but with a shorter drainage days.
Collapse
Affiliation(s)
- Qi Li
- Department of Nephrology, The Second Hospital Of Jilin University, Changchun
- Department of Nephrology, Jilin City Central Hospital, Jilin
| | - Bai Zhu
- Department of Nephrology, Jilin City Central Hospital, Jilin
| | - Xueyan Zhu
- Department of Nephrology, Jilin City Central Hospital, Jilin
| | - Chenglin Piao
- Department of Nephrology, Jilin City Central Hospital, Jilin
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital Of Jilin University, Changchun
| | - Yangwei Wang
- Department of Nephrology, The Second Hospital Of Jilin University, Changchun
| | - Jing Sun
- Department of Nephrology, The Second Hospital Of Jilin University, Changchun
| | - Wenguo Chen
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lining Miao
- Department of Nephrology, The Second Hospital Of Jilin University, Changchun
- ∗Correspondence: Lining Miao, Department of Nephrology, The Second Hospital of Jilin University, Changchun, China (e-mail: )
| |
Collapse
|
15
|
Li CC, Hsu CW, Li CZ, Kuo SM, Wu YC. Successful treatment of a pancreatic pseudocyst accompanied by massive hemothorax: a case report. J Med Case Rep 2015; 9:295. [PMID: 26714770 PMCID: PMC4696274 DOI: 10.1186/s13256-015-0791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is rare to encounter massive hemothorax as a complication of pancreatic pseudocyst. In addition, as no obvious hypotension and abdominal discomfort were noted, it was difficult to consider gastrointestinal lesion a possibility. CASE PRESENTATION A 54-year-old Taiwanese man had tightness on the left side of his chest and shortness of breath for 3 days. He had a history of acute pancreatitis 3 months ago. After history taking and a series of examinations including thoracocentesis and computed tomography of his abdomen and chest, the diagnosis was finally confirmed based on the high amylase levels in his pleural fluid. CONCLUSIONS Treatment with distal pancreatectomy and splenectomy was subsequently successfully performed. Based on our experience, we briefly discuss the currently available treatment options for pancreatic pseudocyst.
Collapse
Affiliation(s)
- Chiao-Ching Li
- Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
| | - Chin-Wen Hsu
- Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
| | - Chiao-Zhu Li
- Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Shyh-Ming Kuo
- Department of Biomedical Engineering, I-Shou University (Yanchao Campus), Kaohsiung, Taiwan.
| | - Yu-Chiuan Wu
- Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan.
- National Kaohsiung University of Hospitality and Tourism, Kaohsiung, Taiwan.
| |
Collapse
|
16
|
Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis (with video). Surg Endosc 2015; 30:1235-41. [PMID: 26275532 DOI: 10.1007/s00464-015-4331-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/09/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pancreatic pseudocysts and walled-off necrosis are well-known complications, described in 10% of cases of acute pancreatitis. Open cystogastrostomy is usually proposed after failure of minimally invasive drainage or in the presence of septic shock. The objective of this study was to evaluate the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy for treatment of symptomatic pancreatic pseudocyst with pancreatic necrosis. MATERIALS AND METHODS Between January 2011 and October 2014, all patients with pseudocyst and pancreatic necrosis undergoing open cystogastrostomy were included. Surgical procedure was standardized. The primary efficacy endpoint was the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy as treatment of symptomatic pancreatic pseudocyst. Secondary endpoints included demographic data, preoperative management, operative data, postoperative data and follow-up. RESULTS Laparoscopy-assisted open cystogastrostomy was performed in 11 patients [six men (54%)], with a median age of 61 years (45-84). Nine patients received preoperative radiological or endoscopic management. First-line open cystogastrostomy was performed in two cases. Median operating time was 190 min (110-240). There was one intraoperative complication related to injury of a branch of the superior mesenteric vein. There were no postoperative deaths and two postoperative complications (18%) including one major complication (postoperative bleeding). The median length of hospital stay after surgery was 16 days (7-35). The median follow-up was 10 months (2-45). One patient experienced recurrence during follow-up. CONCLUSION Open cystogastrostomy for necrotizing pancreatitis promotes adequate internal drainage with few postoperative complications and a short length of hospital stay. However, this technique must be performed very cautiously due to the risk of vascular injury which can be difficult to repair in the context of severe local inflammation related to pancreatic necrosis.
Collapse
|
17
|
Abstract
This article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery, have been employed for the management of pancreatic pseudocysts. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of optimal therapy. We evaluated the treatment modalities used in 893 patients diagnosed with pancreatic pseudocysts according to the revision of the Atlanta classification in our department between 2001 and 2010. All the pancreatic pseudocysts have course of disease >4 weeks and have mature cysts wall detected by computed tomography or transabdominal ultrasonography. Endoscopic drainage, percutaneous drainage, or open surgery was selected on the basis of the pseudocyst characteristics. Clinical data and patient outcomes were reviewed. Among the 893 patients, 13 (1.5%) had percutaneous drainage. Eighty-three (9%) had type I pancreatic pseudocysts and were treated with observation. Ten patients (1%) had type II pseudocysts and underwent the Whipple procedure or resection of the pancreatic body and tail. Forty-six patients (5.2%) had type III pseudocysts: 44 (4.9%) underwent surgical internal drainage and 2 (0.2%) underwent endoscopic drainage. Five hundred six patients (56.7%) had type IV pseudocysts: 297 (33.3%) underwent surgical internal drainage and 209 (23.4%) underwent endoscopic drainage. Finally, 235 patients (26.3%) had type V pseudocysts: 36 (4%) underwent distal pancreatectomy or splenectomy and 199 (22.3%) underwent endoscopic drainage. A new classification system was devised, based on the size, anatomical location, and clinical manifestations of the pancreatic pseudocyst along with the relationship between the pseudocyst and the pancreatic duct. Different therapeutic strategies could be considered based on this classification. When clinically feasible, endoscopic drainage should be considered the optimal management strategy for pancreatic pseudocysts.
Collapse
Affiliation(s)
- Gang Pan
- From the Department of Liver Surgery (GP, K-LX, WL, HW); Department of Pancreatic Surgery (MHW, W-FT); Department of Integrated Traditional and Western Medicine (W-MH, X-BL), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Wang GC, Misra S. A giant pancreatic pseudocyst treated by cystogastrostomy. BMJ Case Rep 2015; 2015:bcr-2014-207271. [PMID: 25804943 DOI: 10.1136/bcr-2014-207271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We report a case of a giant pancreatic pseudocyst in a 65-year-old man presenting with abdominal pain, loss of appetite and abdominal distension. CT scans demonstrated a giant pancreatic pseudocyst measuring 25.7 cm×15.3 cm×10.9 cm anteroposteriorly, with significant compression of surrounding organs. An open cystogastrostomy was performed through a midline incision, and 3 L of fluid was drained from the giant pseudocyst. Recovery has been uneventful.
Collapse
Affiliation(s)
- Grace C Wang
- Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, USA
| | - Subhasis Misra
- Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, USA
| |
Collapse
|
19
|
Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part II: Diagnosis, complications, and management. Dis Mon 2015; 61:5-37. [PMID: 25681098 DOI: 10.1016/j.disamonth.2014.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
20
|
Whitehead DA, Gardner TB. Evidence-Based Management of Necrotizing Pancreatitis. ACTA ACUST UNITED AC 2014; 12:322-32. [DOI: 10.1007/s11938-014-0018-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
21
|
Malamut G, Foulkes C, Fournier L, Hollande C, Berger A, Cellier C. Necrotizing pancreatitis complicated by oesophageal haemorrhage. Pancreatology 2013; 14:146-7. [PMID: 24650970 DOI: 10.1016/j.pan.2013.12.002] [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: 04/09/2013] [Revised: 11/17/2013] [Accepted: 12/12/2013] [Indexed: 12/11/2022]
Abstract
Bleeding is a rare complication of pancreatic pseudocyst. We describe an exceptional case of necrotizing pseudocyst with mediastinal extension providing cataclysmic oesophageal haemorrhage. The patient was successfully treated by adequate endoscopic, radiological and surgical management.
Collapse
Affiliation(s)
- Georgia Malamut
- Université Paris Descartes, Paris, France; Gastroenterology Department, Hôpital Européen Georges Pompidou APHP, Paris, France; Inserm U989, Paris, France.
| | - Charles Foulkes
- Université Paris Descartes, Paris, France; Digestive Surgery Department, Hôpital Européen Georges Pompidou APHP, Paris, France
| | - Laure Fournier
- Université Paris Descartes, Paris, France; Radiology Department, Hôpital Européen Georges Pompidou APHP, Paris, France
| | - Clémence Hollande
- Université Paris Descartes, Paris, France; Gastroenterology Department, Hôpital Européen Georges Pompidou APHP, Paris, France
| | - Anne Berger
- Université Paris Descartes, Paris, France; Digestive Surgery Department, Hôpital Européen Georges Pompidou APHP, Paris, France
| | - Christophe Cellier
- Université Paris Descartes, Paris, France; Gastroenterology Department, Hôpital Européen Georges Pompidou APHP, Paris, France; Inserm U989, Paris, France
| |
Collapse
|
22
|
Flug JA, Garnet DJ, Widmer J, Stavropoulos S, Gidwaney R, Katz DS, Abbas MA. Advanced gastrointestinal endoscopic procedures: indications, imaging findings, and implications for the radiologist. Clin Imaging 2013; 37:624-30. [DOI: 10.1016/j.clinimag.2012.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 12/17/2012] [Indexed: 01/10/2023]
|
23
|
Ogura T, Masuda D, Higuchi K. A patient with obstructive jaundice. Gastroenterology 2013; 144:e9-e10. [PMID: 23462120 DOI: 10.1053/j.gastro.2013.01.015] [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: 12/29/2012] [Accepted: 01/07/2013] [Indexed: 12/02/2022]
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | | |
Collapse
|
24
|
Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol 2012; 24:1355-62. [PMID: 23114741 DOI: 10.1097/meg.0b013e32835871eb] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.
Collapse
|
25
|
Abstract
AIM The aim of the present study was to review the use of endoscopic cyst gastrostomy (E-CG) as a treatment option for pancreatic pseudocysts referred to a tertiary paediatric surgical centre. METHODS Retrospective review during a 10-year period (January 2001-December 2010). Cyst gastrostomies were performed using 1 or 2 double pigtailed Zimmon stents (7-10 Fr) under general anaesthesia. Data are quoted as median (range). RESULTS E-CG was performed in 7 (5 males) children (median age at presentation 11.7 [8.2-15.8] years). Pancreatic pseudocysts were caused by acute pancreatitis in 5 (gallstones n = 1, hereditary pancreatitis n = 1, pancreatic divisum n = 1, asparaginase induced n = 1, and idiopathic n = 1) and pancreatic trauma in 2 (motor vehicle accident n = 1, and handlebar injury n = 1). All of the cases were associated with a rise in serum amylase level, median 1028 (276-2077) IU/L at the peak of symptoms. Three children had pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography as the initial therapeutic intervention, but went on to have E-CG later. One who had a huge pseudocyst at presentation had already undergone an open cyst gastrostomy, which had recurred at 1 month. Rescue E-CG was performed 38 days later. All of the stents were removed endoscopically at 8 (6-40) weeks. E-CG was uncomplicated and pseudocysts resolved completely in 5. One required repeat placement at 15 days due to catheter slippage with later full resolution. One child required open cyst gastrostomy due to reaccumulation two months following removal of the stent. Median hospital stay post E-CG was 3 (1-23) days. There has been no recurrence at median follow-up of 18 (5-108) months. CONCLUSIONS Endoscopic cyst gastrostomy is a safe and effective alternative for the management of pancreatic pseudocysts in children and should now be considered as treatment of choice.
Collapse
|
26
|
Elkhatib I, Savides T, Fehmi SMA. Pancreatic fluid collections: Physiology, natural history, and indications for drainage. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2012. [DOI: 10.1016/j.tgie.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
27
|
Cruz-Santamaría DM, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. World J Gastrointest Pathophysiol 2012; 3:60-70. [PMID: 22737590 PMCID: PMC3382704 DOI: 10.4291/wjgp.v3.i3.60] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/22/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP), defined as the acute nonbacterial inflammatory condition of the pancreas, is derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues and other organs. So, it is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications and generally resolves over time. Different conditions are known to induce this disorder, although the innermost mechanisms and how they act to develop the disease are still unknown. We summarize some well established aspects. A phase sequence has been proposed: etiology factors generate other conditions inside acinar cells that favor the AP development with some systemic events; genetic factors could be involved as susceptibility and modifying elements. AP is a disease with extremely different clinical expressions. Most patients suffer a mild and limited disease, but about one fifth of cases develop multi organ failure, accompanied by high mortality. This great variability in presentation, clinical course and complications has given rise to the confusion related to AP related terminology. However, consensus meetings have provided uniform definitions, including the severity of the illness. The clinical management is mainly based on the disease´s severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself. The first step is to determine if it is mild or severe. We review the principal aspects to be considered in this treatment, as reflected in several clinical practice guidelines. For the last 25 years, there has been a global increase in incidence of AP, along with many advances in diagnosis and treatment. However, progress in knowledge of its pathogenesis is scarce.
Collapse
|
28
|
Abstract
OBJECTIVES The aim of this study was to analyze the incidence, risk factors, and clinical outcomes of pancreatic pseudocyst after acute or acute-on-chronic pancreatitis. METHODS We retrospectively reviewed the medical records of 350 patients with acute pancreatitis and 55 patients with acute-on-chronic pancreatitis. RESULTS Pancreatic pseudocyst developed in 14.6% of acute pancreatitis and in 41.8% of acute-on-chronic pancreatitis (P = 0.00). In the acute-on-chronic pancreatitis group, interval from symptom onset to hospital visit was longer, and the incidence of recurrent pancreatitis and alcoholic etiology was higher than that of the acute pancreatitis group (P < 0.01). There was no significant difference in the spontaneous resolution rate between both groups. Of the total 68 conservatively treated patients with pseudocyst, the pseudocyst decreased in size or disappeared in 77.9% and showed no change in 1.5%. The risk factors of pseudocyst were the presence of underlying chronic pancreatitis, the interval from symptom onset to visiting the hospital, and an alcoholic etiology. The factor-predicted spontaneous resolution was a single lesion. CONCLUSIONS Pseudocyst developed more frequently in patients with acute-on-chronic pancreatitis, and most pseudocysts improved spontaneously irrespective of underlying chronic pancreatitis. A longer period of a "wait-and-see" policy for more than 6 weeks is suggested for asymptomatic pseudocyst, especially for a single lesion.
Collapse
|
29
|
Pancreatic pseudocyst: therapeutic dilemma. Int J Inflam 2012; 2012:279476. [PMID: 22577595 PMCID: PMC3345229 DOI: 10.1155/2012/279476] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/17/2012] [Indexed: 02/08/2023] Open
Abstract
Pancreatic pseudocyst develops in both acute and chronic pancreatitis. It is an entity likely to either remain asymptomatic or develop devastating complications. Despite being diagnosed easily, treatment exercise is still at crossroads whether in the form of internal or external drainage or endoscopic, laparoscopic, or open intervention with a good radiological guidance. The therapeutic dilemma whether to treat a patient with a pancreatic pseudocyst, as well as when and with what technique, is a difficult one. This paper is intended to get information about diagnostic and therapeutic exercises most appropriate for acute and chronic pancreatic pseudocyst.
Collapse
|
30
|
|
31
|
Abstract
Techniques of endoscopic pseudocyst management continue to evolve, but the principles of proper patient selection and careful consideration of the available therapeutic options remain unchanged. Endoscopic management is considered first-line therapy in the treatment of symptomatic pseudocysts. Clinicians should be vigilant in the evaluation of all peripancreatic fluid collections to exclude the presence of a pancreatic cystic neoplasm and avoid draining an immature collection. Expectant management with periodic observation should be considered for the minimally symptomatic patients, even after the traditional 6 weeks of maturation. Further, symptoms, complications, and expansion on serial imaging should prompt intervention by endoscopic, surgical, or percutaneous methods. Pseudocysts should only be punctured when the wall has had sufficient time to mature and after pseudoaneurysm has been ruled out by careful imaging. Small to moderately sized pseudocysts (< 4–6 cm) that communicate with the pancreatic duct are good candidates for endoscopic transpapillary stenting. For larger lesions requiring transmural drainage, EUS guidance is preferable, but good results can be achieved with ENL. EUS may be particularly useful in permitting drainage in patients with suspected perigastric varices or if an endoscopically visible bulge is not apparent. Necrosis is a significant factor for a worse outcome; aggressive debridement with nasocystic or percutaneous endoscopic gastrostomy-cystic catheter lavage plus manual endoscopic techniques for clearing debris should be used. Endoscopic failure, especially in cases with significant necrosis, should be managed operatively. Percutaneous drainage is a good option for immature infected pseudocysts or in patients who are not optimal candidates for other procedures. Close cooperation between endoscopists, surgeons, interventional radiologists, and other healthcare providers is paramount in successfully managing these patients.
Collapse
|
32
|
Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci 2011; 56:902-8. [PMID: 20676768 DOI: 10.1007/s10620-010-1350-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/12/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND While pancreatitis is uncommon in children, pseudocyst development can be a serious complication. Endoscopic drainage of pseudocysts is well established in adults. However, there are limited data regarding this procedure in a pediatric population. The objective of this study is to determine the safety and efficacy of endoscopic ultrasound-guided pseudocyst drainage in children. METHODS The study group included children (age <18 years) who presented for endoscopic drainage of symptomatic pancreatic pseudocysts in whom endoscopic ultrasound (EUS) was performed. In those cases with EUS guidance, a 19-gauge needle was used to access the pseudocyst and place a guidewire under fluoroscopic visualization. Needle-knife diathermy and balloon dilation of the tract were performed with subsequent placement of double pig-tailed stents for drainage. RESULTS Ten children with mean age of 11.8 years (range 4-17 years) were analyzed for pancreatic pseudocysts due to biliary pancreatitis (n = 4), trauma (n = 2), familial pancreatitis (n = 1), idiopathic pancreatitis (n = 2), and pancreas divisum (n = 1). In eight cases, EUS-guided puncture and stent placement was successful. In the remaining two cases, aspiration of cyst fluid until complete collapse was adequate. As experience increased with EUS examination in children, the therapeutic EUS scope alone was used in 50% of cases for the entire procedure. In all ten cases, successful transgastric endoscopic drainage of pseudocysts was achieved. CONCLUSIONS Endoscopic drainage of symptomatic pancreatic pseudocysts can be achieved safely in children. EUS guidance facilitates optimal site of puncture as well as placement of transmural stents.
Collapse
Affiliation(s)
- Saad F Jazrawi
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 9083, Dallas, TX 75390-9151, USA
| | | | | |
Collapse
|
33
|
Boutros C, Somasundar P, Espat NJ. Open cystogastrostomy, retroperitoneal drainage, and G-J enteral tube for complex pancreatitis-associated pseudocyst: 19 patients with no recurrence. J Gastrointest Surg 2010; 14:1298-303. [PMID: 20535579 DOI: 10.1007/s11605-010-1242-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 05/25/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Various techniques have been described to achieve definitive resolution of complex acute pancreatitis associated pseudocysts (PACs). Many of these strategies, inclusive of open, minimally invasive, and radiological procedures, are hampered by high recurrence or failed resolution, particularly for PAC near the pancreatic head. The present series describes a multimodal strategy combining a minilaparotomy for anterior gastrostomy for the creation of a stapled posterior cystogastrostomy, placement of an 8F secured silastic tube for intentional formation of a cystogastric fistula tract in combination with gastric drainage, and postduodenal enteral alimentation. MATERIALS AND METHODS Using a prospectively maintained hepatobiliary database, patients with complex PAC undergoing the above procedures were identified. PAC location, postoperative length of stay (LOS), and time to start enteral feeding were identified. PAC were assessed by computed tomography (CT) scan prior to operation, 1 month after drainage, and patients with PAC resolution were started on oral diet, with the fistula silastic tube kept in place for an additional month. RESULTS Over the interval 2003 to 2008, 19 patients were managed with the stated strategy. PACs were located at the pancreatic body/tail in 12 patients, and 7 patients had PAC at the level of the pancreatic head/neck area. In this cohort, prior to surgical drainage, 17/19 patients had undergone failed endoscopic retrograde cholangiopancreatography (ERCP) with decompressive stent placement and 13/19 had a failed percutaneous PAC drainage. There was no perioperative mortality after open surgical drainage. All patients started on jejunal tube feeding 24 h after surgical procedure. Median postoperative LOS was 7 days (4-13). At 1 month, 16/19 (84%) of patients showed complete resolution of the PAC on CT scan and were started on oral diet; 3/19 required additional month for complete resolution. After a mean follow-up of 31 months, there was no PAC recurrences in any of these patients demonstrated on follow-up. CONCLUSION The described strategy is safe, efficient, and allows early restoration of enteral feeding with early hospital discharge. High resolution rates and absence of PAC recurrences in this series supports this approach for complex PAC.
Collapse
Affiliation(s)
- Cherif Boutros
- Hepatobiliary and Oncologic Surgery, Roger Williams Medical Center, Providence, RI, USA
| | | | | |
Collapse
|
34
|
Andersson B, Andrén-Sandberg A, Andersson R. Survey of the management of pancreatic pseudocysts in Sweden. Scand J Gastroenterol 2010; 44:1252-8. [PMID: 19658018 DOI: 10.1080/00365520903132005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The management of pancreatic pseudocysts varies, based mainly on local traditions, resources and expertise. No prospective, randomized study has been done comparing different approaches to treatment. The aim of the present study was to identify current treatment strategies in Sweden. MATERIAL AND METHODS A questionnaire comprising 12 questions was e-mailed to the surgical departments of all hospitals (n=58) treating patients with pancreatitis. Comparisons were made between university and non-university hospitals and between hospitals with 150,000 or more persons versus less in the primary catchment area. RESULTS Fifty-one hospitals responded (88%). In median, 4 (0-25) patients were treated yearly due to pancreatic pseudocysts at each hospital. Five hospitals had written guidelines. Multidisciplinary team conferences were held at 36/48 centres. Treatment strategies for acute compared to chronic pancreatitis associated pseudocysts differed significantly depending on the underlying diagnosis in the major hospitals (p=0.005). Overall, 21/49 hospitals refer some of these patients and 15/50 of the departments state that they regularly assist in taking care of patients with pancreatic pseudocysts from other hospitals. The chosen treatment modalities vary widely, above all concerning endoscopic drainage, which is more common for symptomatic non-infected pseudocysts (p=0.005) as well as infected pseudocysts (p=0.004) in university hospitals. CONCLUSIONS The lack of protocols and management strategies for pancreatic pseudocysts is reflected by the heterogeneity in treatment strategies, as seen in the present survey. Therefore patients may be at risk of receiving suboptimal treatment. A tailored therapeutic approach that takes into consideration patient preferences and involves a multidisciplinary team should be considered in all cases.
Collapse
Affiliation(s)
- Bodil Andersson
- Department of Surgery, Lund University Hospital, Lund, Sweden.
| | | | | |
Collapse
|
35
|
Yadav SK, Gupta V, Khan AA. Spontaneous duodenal fistulization of pseudocyst of pancreas: A rare entity in children. J Indian Assoc Pediatr Surg 2010; 15:32-3. [PMID: 21180504 PMCID: PMC2998668 DOI: 10.4103/0971-9261.69141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The spontaneous resolution of pseudopancreatic cyst due to internal fistulization into the duodenum in a 4-year-old male child is described here. This is rare and the child presented initially with features of duodenal obstruction. Upper gastrointestinal endoscopy and computed tomography scan confirmed the diagnosis and the unusual mode of resolution of this entity.
Collapse
Affiliation(s)
- Sunil Kumar Yadav
- Department of Pediatric and Neonatal Surgery, IBN Sina Hospital, Kuwait
| | - Vipul Gupta
- Department of Pediatric and Neonatal Surgery, IBN Sina Hospital, Kuwait
| | - Ashhad Ali Khan
- Department of Pediatric and Neonatal Surgery, IBN Sina Hospital, Kuwait
| |
Collapse
|
36
|
Abstract
Endoscopic ultrasound (EUS) has become well established as a diagnostic modality in gastrointestinal cancer staging. It offers high-resolution imaging and fine-needle biopsy, which is essential in tumor and nodal staging of gastrointestinal cancers. In the recent decade, however, many therapeutic applications of EUS have become possible. Currently, interventional EUS endoscopy involves celiac plexus neurolysis, pseudocyst drainage, and intratumoral fine-needle injection therapy for inoperable pancreatic malignancy. Emerging techniques include the accurate endoscopic delivery of radioactive beads to localize tumor therapy as well as other therapies, such as radiofrequency ablation or cryotherapy. Diagnostic and therapeutic access to the biliary tree and pancreatic duct is increasingly being used successfully in failed endoscopic retrograde cholangiopancreatography (ERCP) procedures. This review discusses these procedures and several evolving future applications, including vascular access and EUS-guided enteral anastomosis.
Collapse
|
37
|
Pancreatic pseudocyst with pancreatolithiasis and intracystic hemorrhage treated with distal pancreatectomy: a case report. CASES JOURNAL 2009; 2:8693. [PMID: 19918394 PMCID: PMC2769464 DOI: 10.4076/1757-1626-2-8693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 07/29/2009] [Indexed: 11/17/2022]
Abstract
Introduction Hemorrhage from pancreatic pseudocyst is one of the serious complications of chronic pancreatitis. We experienced intracystic hemorrhage from a huge pancreatic pseudocyst and successfully treated it with distal pancreatectomy. Case presentation A 65-year-old-man with a history of alcohol abuse was admitted to our hospital for abdominal pain and was diagnosed as having chronic pancreatitis with pancreatolithiasis and pseudocyst in the pancreatic tail. The pancreatic pseudocyst increased in size gradually for 4 month observation period. For intracystic hemorrhage we performed an urgent distal pancreatectomy with splenectomy. Postoperative course was good and the elevated serum amylase level decreased to the normal range. Conclusion Prolonged observation resulted in intracystic hemorrhage. Drainage or surgery in adequate time is important for the management of pancreatic pseudocysts to prevent complications.
Collapse
|
38
|
Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, Gualdi GF. Imaging assessment of acute pancreatitis: a review. Semin Ultrasound CT MR 2009; 29:322-40. [PMID: 18853839 DOI: 10.1053/j.sult.2008.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.
Collapse
Affiliation(s)
- Mariano Scaglione
- Department of Diagnostic Imaging, Clinica Pineta Grande, Castel Volturno, Caserta, Italy.
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.
Collapse
|
40
|
Offord S, Gumustop B, Shepard A. Pancreatic pseudocystwith stent placement in the background of narcotic use: a case report. CASES JOURNAL 2008; 1:219. [PMID: 18840260 PMCID: PMC2572047 DOI: 10.1186/1757-1626-1-219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 10/07/2008] [Indexed: 11/10/2022]
Abstract
A 49 year old gentleman presents with recurrent abdominal pain. The patient has a known history of chronic pancreatitis, alcoholism and narcotic addiction. Work-up, including computed tomography (CT) of the abdomen, demonstrated a 5.6 × 5.8 cm fluid collection contiguous with the pancreas. This was not seen on CT 18 months earlier. The patient's pain did not improve with bowel rest and pain control. He was transferred to another institution for endoscopic placement of a transgastric pancreatic stent. The procedure decreased the size the cyst and the patient's pain became more manageable.
Collapse
|
41
|
Abstract
Pancreatic pseudocysts are a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. Diagnosis is accomplished most often by computed tomographic scanning, by endoscopic retrograde cholangiopancreatography, or by ultrasound, and a rapid progress in the improvement of diagnostic tools enables detection with high sensitivity and specificity. Different strategies contribute to the treatment of pancreatic pseudocysts: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, or open surgery. The feasibility of endoscopic drainage is highly dependent on the anatomy and topography of the pseudocyst, but provides high success and low complication rates. Percutaneous drainage is used for infected pseudocysts. However, its usefulness in chronic pancreatitis-associated pseudocysts is questionable. Internal drainage and pseudocyst resection are frequently used as surgical approaches with a good overall outcome, but a somewhat higher morbidity and mortality compared with endoscopic intervention. We therefore conclude that pseudocyst treatment in chronic pancreatitis can be effectively achieved by both endoscopic and surgical means. This review entails publications referring to the classification of pancreatic pseudocysts, epidemiology, diagnostic tools, and therapeutic options for pancreatic pseudocysts. Only full articles were considered for the review. Based on a search in PubMed, the MeSH terms "pancreatic pseudocysts and classification," "diagnosis," and "endoscopic, percutaneous, and surgical treatment" were used either alone or in combination.
Collapse
|
42
|
Bergman S, Melvin WS. Operative and nonoperative management of pancreatic pseudocysts. Surg Clin North Am 2008; 87:1447-60, ix. [PMID: 18053841 DOI: 10.1016/j.suc.2007.09.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The management of pancreatic pseudocysts has changed greatly over the last decade. As laparoscopic and endoscopic techniques continue to evolve, their use in the treatment of pseudocysts has gained acceptance, whereas the role of percutaneous drainage has become more limited. The literature on laparoscopic, endoscopic, and percutaneous management of pancreatic pseudocyst is reviewed here and, based on these data, a treatment algorithm is suggested.
Collapse
Affiliation(s)
- Simon Bergman
- Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University, 558 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA
| | | |
Collapse
|
43
|
Abstract
Almost all the therapeutic efforts in the treatment of chronic pancreatitis are directed towards pain control. Endoscopic techniques available for this purpose are endoscopic retrograde cholangiopancreatography (combined or not with extracorporeal shock wave lithotripsy) and endoscopic ultrasound. Pancreatic stones and strictures, pancreatic pseudocysts, and common bile duct strictures complicating chronic pancreatitis can be treated by endoscopy. The development of endoscopic ultrasound extended the possibilities in the treatment of pancreatic pseudocysts and main pancreatic duct drainage. Endoscopy is considered the first-line treatment in chronic pancreatitis and can be useful also as a 'bridge to surgery'. In fact the endoscopic approach to chronic pancreatitis can predict the response to surgical therapy as a definitive treatment. Medical, endoscopic and surgical methods for the management of chronic pancreatitis should all be considered in decision-making, and the best treatment should be chosen case by case and according to the local expertise.
Collapse
|
44
|
Lu X, Uchida E, Yokomuro S, Nakamura Y, Aimoto T, Tajiri T. Features and choice of treatment of acute and chronic pancreatic pseudocysts--with special reference to invasive intervention. Pancreatology 2008; 8:30-5. [PMID: 18235214 DOI: 10.1159/000114853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 09/02/2007] [Indexed: 12/11/2022]
Abstract
AIMS It was the aim of this study to characterize the features of acute and chronic pancreatic pseudocysts (PPs) and to identify the factors predictive of the need for invasive treatment. METHODS Thirty-six patients with PPs treated at Nippon Medical School between January 1995 and December 2004 were studied retrospectively. The cases were divided into 4 groups based on 4 features: association with acute pancreatitis, association with chronic pancreatitis, spontaneous resolution, and persistent symptoms requiring therapeutic intervention. Group 1 included 9 patients with acute PPs which resolved spontaneously. Group 2 included 9 patients with acute PPs with persistent symptoms or associated complications requiring interventional treatment. Group 3 included 9 patients with chronic PPs which resolved spontaneously, and group 4 included 9 patients with chronic PPs with persistent symptoms or associated complications requiring interventional treatment. RESULTS Among the 36 patients, 13 were women and 23 were men. The etiologies were pancreatitis due to alcoholism in 18 cases (50.0%), biliary tract disease in 8 cases (22.2%) and other conditions in 10 cases (27.8%). The average duration of follow-up was 24.2 +/- 18.5 months. The patients in group 1 were significantly older than those in group 2 (67.6 +/- 16.1 vs. 40.6 +/- 14.1 years; p = 0.011). The mean size of the PPs was significantly larger in groups 1 and 4 than in group 3 (p < 0.05) and significantly larger in group 2 than in group 4 (p < 0.05). There were no significant differences between groups 1 and 2 in the size of the PPs or in the Ranson score of previous pancreatitis. The increase in size of the PPs during follow-up in each of the spontaneously resolved groups (groups 1 and 3) differed significantly from that in each of the interventional treatment groups (groups 2 and 4; p < 0.05). The main cause of the acute pancreatitis in group 1 was biliary tract disease, while that in group 2 was alcoholism (significantly different, p < 0.05). The number of patients with symptoms related to pseudocysts at the time of diagnosis was significantly higher in group 1 than in group 3. CONCLUSIONS Growth of the PPs during follow-up is the strongest predictor of the need for invasive treatment in both acute and chronic cases. Among acute PPs, the size of the pseudocyst is not in itself a predictor of invasive treatment. Invasive treatment may pose higher risks for pseudocysts with an etiology of alcoholic acute pancreatitis. However, the size of the pseudocyst may be a more important prognostic factor than an etiology of pancreatitis. and IAP.
Collapse
Affiliation(s)
- Xiaolan Lu
- Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | | | | | | | | |
Collapse
|
45
|
Marshall JC. Acute Pancreatitis. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
46
|
Casado D, Sabater L, Calvete J, Mayordomo E, Aparisi L, Sastre J, Lledo S. Multiple intrahepatic pseudocysts in acute pancreatitis. World J Gastroenterol 2007; 13:4655-7. [PMID: 17729426 PMCID: PMC4611847 DOI: 10.3748/wjg.v13.i34.4655] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver pseudocysts are a very rare complication in acute pancreatitis with only a few cases previously described. The lack of experience and literature on this condition leads to difficulties in the differential diagnosis and management. We report herein a case of acute pancreatitis who developed multiple intrahepatic pseudocysts. After complete imaging evaluation, the diagnosis was still unclear and the patient was operated on. The presence of liver lesions in patients with acute pancreatitis should raise the possibility of intrahepatic pseudocysts.
Collapse
Affiliation(s)
- David Casado
- Department of Surgery, Liver, Biliary and Pancreatic Unit, University of Valencia, Valencia, Spain
| | | | | | | | | | | | | |
Collapse
|
47
|
Mas E, Barange K, Breton A, de Maupéou F, Juricic M, Broué P, Olives JP. Endoscopic cystostomy for posttraumatic pseudocyst in children. J Pediatr Gastroenterol Nutr 2007; 45:121-4. [PMID: 17592375 DOI: 10.1097/mpg.0b013e31802c6983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Emmanuel Mas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital, Toulouse, France.
| | | | | | | | | | | | | |
Collapse
|
48
|
Piraka C, Chen YK. Pseudocyst Drainage: ERCP and EUS Approaches. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2007. [DOI: 10.1016/j.tgie.2007.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
49
|
Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, Harrison P, Davenport M. Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg 2007; 42:629-35. [PMID: 17448757 DOI: 10.1016/j.jpedsurg.2006.12.025] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The management of children with main pancreatic duct injuries is controversial. We report a series of patients with pancreatic trauma who were treated using minimally invasive techniques. METHODS Retrospective review of children with pancreatic trauma treated at a UK tertiary referral institution between 1999 and 2004. RESULTS Fifteen children (11 boys) were admitted with pancreatic trauma. Twelve (80%) were less than 50th centile for body weight. Contrast-enhanced computed tomography (CT) scans were used to define organ injury, supplemented by magnetic resonance cholangiopancreatography (MRCP) in 7. Twelve (80%) underwent diagnostic endoscopic retrograde cholangiopancreatography (ERCP) with a median time after injury of 11 (range, 6-29) days. The degree of pancreatic injury was defined by ERCP and CT/MRCP as grade II (n = 2), grade III (n = 4), grade IV (n = 9) (American Association for the Surgery of Trauma grades). Nine children had a transductal pancreatic stent inserted endoscopically. Computed tomography/ultrasound-guided drainage was performed in 4 children for acute fluid collections. Two children later underwent endoscopic cyst-gastrostomy, one of whom later required conversion to an open cyst-gastrostomy. CONCLUSION Body habitus may predispose to pancreatic duct trauma. Contrast-enhanced CT scan (and MRCP) should dictate the need for ERCP. Transductal pancreatic stenting allows internal drainage of peripancreatic collections and may reestablish duct continuity, although a proportion still requires percutaneous or endoscopic cyst-gastrostomy drainage. Open surgery for pancreatic trauma should now be an exception.
Collapse
Affiliation(s)
- Christophe H Houben
- Department of Pediatric Surgery, Kings College Hospital, Denmark Hill, SE5 9RS London, UK
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
We report the case of a 42-year-old man with a large pancreatic pseudocyst, the presence of which was not suspected upon initial presentation. This case provides an example of when imaging may be useful for the detection of pancreatitis and its complications. It also demonstrates classic pseudocyst localization to the lesser sac and left anterior pararenal space. The unusually large size of this pseudocyst provides a clear delineation of retroperitoneal fascial planes and an illustration of possible clinical consequences of mechanical obstruction by pseudocyst.
Collapse
|