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Groskreutz D, Ahmad Y, Vargas J, Assaker R. Interventional management and diagnostic follow-up of a large pancreatic pseudocyst: A case report. Radiol Case Rep 2022; 18:60-63. [PMID: 36324848 PMCID: PMC9619330 DOI: 10.1016/j.radcr.2022.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
We present a case of a large pancreatic pseudocyst in a 69-year-old man following post biopsy pancreatitis. Radiological findings revealed a thick-walled, fluid filled mass in proximity to the pancreas. Although pancreatic pseudocysts generally self-resolve, extensive or complicated cysts may require surgical or interventional management. Pseudocyst size >6 cm, compression of the inferior vena cava or biliary duct, and severe symptoms often prognosticate the need for intervention.
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Affiliation(s)
- Derek Groskreutz
- Frank H. Netter MD School of Medicine, Quinnipiac University, 370 Bassett Rd, North Haven, CT 06473, USA
- Corresponding author.
| | - Yasir Ahmad
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Jose Vargas
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Richard Assaker
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
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Effect of Early Continuous Veno-Venous Haemofiltration in Severe Acute Pancreatitis for the Prevention of Local Pancreatic Complications. Gastroenterol Res Pract 2022; 2022:7575231. [PMID: 35296066 PMCID: PMC8920652 DOI: 10.1155/2022/7575231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 02/12/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To compare the conventional treatment and continuous veno-venous haemofiltration (CVVH) in severe acute pancreatitis (SAP) for the prevention of pseudocyst and walled-off necrosis. Patients and Methods. Forty-two patients were divided into two treatment groups: conventional treatment group contained 24 patients and CVVH had 18. Conventional treatment group patients were treated symptomatically and according to the causes. CVVH group patients were treated symptomatically, and CVVH was done within 2 hours of admission. Results In both groups, there was a decrease in amylase, lipase, CRP, IL-6, IL-10, TNF-alpha, Ranson score, Balthazar score, and APACHE-II score after 72 hours, but the decrease was significantly greater in CVVH patients. There were no any local pancreatic complications in CVVH patients, but 1 patient had an acute peripancreatic fluid collection, 2 patients had pseudocyst, and 2 patients had walled-off necrosis (WON), and a mortality one was seen in the conventional treatment group. Conclusion The present study shows that early CVVH may be able to prevent the formation of pseudocyst and win in SAP patients.
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Lesmana CRA, Herjuningtyas C, Inggriani S, Pratiwi YE, Lesmana LA. Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center. Case Rep Gastroenterol 2021; 15:210-217. [PMID: 33790707 PMCID: PMC7989824 DOI: 10.1159/000513282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022] Open
Abstract
Pancreatobiliary disorder is a challenging clinical condition, especially when this condition is causing severe infection or biliary sepsis, and sometimes it requires intensive care unit (ICU) treatment. Biliary drainage is the mainstay of therapy; however, the choice of the drainage method is dependent on the patient's clinical condition and the disease itself. A 79-year-old female was transferred on a ventilator to our ICU from another hospital due to biliary sepsis, a large common bile duct stone, and an infected pancreatic pseudocyst. The patient also has other comorbidities such as heart problems, hypothyroidism, and diabetes mellitus. Bedside percutaneous transhepatic biliary drainage without fluoroscopy and percutaneous cyst aspiration was successfully performed, which improved the patient's condition; this was followed by an endoscopic approach, i.e., endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided pancreatic pseudocyst drainage. The clinical improvement showed itself in the change of the patient's respiratory status and ventilator mode. In conclusion, the percutaneous approach has a big role in managing critically ill patients in the ICU setting. However, expertise, training experience, and a multidisciplinary team approach are very important for successful management and patient outcome.
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Affiliation(s)
- Cosmas Rinaldi Adithya Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia.,Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
| | | | - Sri Inggriani
- Department of Radiology, Medistra Hospital, Jakarta, Indonesia
| | - Yulia Estu Pratiwi
- Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
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Badgurjar MK, Mandovra P, Mathur SK, Patankar R. Laparoscopic loop cystojejunostomy: An alternative to Roux-en-Y cystojejunostomy for pancreatic pseudocyst. J Minim Access Surg 2021; 17:221-225. [PMID: 32964880 PMCID: PMC8083751 DOI: 10.4103/jmas.jmas_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Surgical internal drainage of pancreatic pseudocyst can be done into the stomach, duodenum or jejunum depending on the anatomic relation of pseudocyst with hollow viscera. For cystojejunostomy, a Roux-en-Y loop is preferred over loop cystojejunostomy as former is thought to avoid the reflux of jejunal contents into the cyst cavity. This study presents our experience with laparoscopic loop cystojejunostomy showing loop cystojejunostomy for the pseudocyst of the pancreas can be safely performed laparoscopically with simpler technique with no complications including reflux.
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Affiliation(s)
- Mohit K Badgurjar
- Department of Digestive Diseases, Zen Multispecialty Hospital, Mumbai, Maharashtra, India
| | - Pranav Mandovra
- Department of Digestive Diseases, Zen Multispecialty Hospital, Mumbai, Maharashtra, India
| | - Surendra K Mathur
- Department of Digestive Diseases, Zen Multispecialty Hospital, Mumbai, Maharashtra, India
| | - Roy Patankar
- Department of Digestive Diseases, Zen Multispecialty Hospital, Mumbai, Maharashtra, India
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Khaladkar SM, Waghmode AM. Unusual Locations of Pancreatic Pseudocysts in Lumbar Triangle, Psoas Muscle and Intercostal Space, and Obturator Externus. J Clin Imaging Sci 2018; 8:33. [PMID: 30197824 PMCID: PMC6118112 DOI: 10.4103/jcis.jcis_29_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022] Open
Abstract
Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, scrotum, liver, spleen, mediastinum, pleura, and lung. Extension of pseudocyst into psoas muscle and lumbar triangle is extremely rare. The development of pseudocyst in lumbar triangle is radiologically equivalent and further extension of Grey Turner's sign seen clinically in acute pancreatitis. This extension occurs due to the destructive nature of pancreatic enzymes. The lumbar triangle is the site of anatomic weakness in the lateral abdominal wall in the lumbar region. We report the case of a 35-year-old alcoholic male patient who presented with abdominal pain followed by distension and swelling in the right lumbar region for 1 week. On computed tomography scan of the abdomen, acute-on-chronic pancreatitis with multiple pseudocysts in the right posterior pararenal space, extending through the right lumbar triangle in the right lateral abdominal wall, right posterior paraspinal muscles, right iliopsoas, right obturator externus, and medial aspect of the right upper thigh, beneath anterior abdominal wall in the upper abdomen and in the right lateral thoracic wall through the right 11th intercostal space, was detected.
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Affiliation(s)
- Sanjay Mhalasakant Khaladkar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Akshay Mahadev Waghmode
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol 2018; 3:18. [PMID: 29682625 DOI: 10.21037/tgh.2018.03.03] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022] Open
Abstract
Pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders. Their management demands the co-operation of surgeons, radiologists and gastroenterologists. Historically, they have been treated either conservatively or surgically, with acceptable rates of complications and recurrence. However, recent advances in radiology and endoscopy, have leaded physicians to implement percutaneous and endoscopic drainage (ED) into their treatment algorithms. Moreover, laparoscopic surgery, with its advantages, has become an attractive alternative choice when surgical drainage (SD) is required. The aim of this review is to summarize the main diagnostic and therapeutic tools in the management of pseudocysts and to present the main studies that compare the three different types of pseudocyst drainage.
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Affiliation(s)
- Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ioannis Passas
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece
| | - Ioannis Sideris
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece
| | - Demetrios Davides
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece
| | - Christos Dervenis
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece.,Department of Surgery, Medical School, University of Cyprus, Nicosia, Cyprus
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Sakata K, Hashimoto D, Taki K, Nakahara O, Ohmuraya M, Chikamoto A, Beppu T, Baba H. Successful surgical internal drainage of postoperative pancreatic pseudocyst through pancreaticojejunostomy with distal pancreatectomy: a case report. Surg Case Rep 2015; 1:54. [PMID: 26366351 PMCID: PMC4560123 DOI: 10.1186/s40792-015-0057-x] [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: 02/25/2015] [Accepted: 06/10/2015] [Indexed: 11/12/2022] Open
Abstract
Pancreatic pseudocyst is usually treated by percutaneous external drainage, endoscopic internal or external drainage, or surgical internal drainage such as cystogastrostomy. Surgical external drainage is an option if these procedures fail. We describe a case of a 70-year-old man with a pancreatic body pseudocyst that developed postoperatively. It was improved by endoscopic external drainage, and the stent was changed to an internal stent. However, surgery was required as the pseudocyst grew again. A direct approach to the pseudocyst was not possible because of severe adhesion. A distal pancreatectomy with pancreaticojejunostomy was performed, and an external pancreatic stent tube was inserted from the cut end into the duodenum to drain the pseudocyst. One month later, the pseudocyst disappeared, and the stent was removed.
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Affiliation(s)
- Kazuya Sakata
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556 Japan
| | - Daisuke Hashimoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556 Japan
| | - Katsunobu Taki
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556 Japan
| | - Osamu Nakahara
- Department of Surgery, Taragi Municipal Hospital, 4210 Taragi, Kumamoto, 868-0598 Japan
| | - Masaki Ohmuraya
- Institute of Resource Development and Analysis, Kumamoto University, 2-2-1 Honjo, Kumamoto, 860-0811 Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556 Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556 Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556 Japan
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Aswani Y, Anandpara KM, Hira P. Extension of pancreatic pseudocyst into psoas muscle in a setting of acute pancreatitis. BMJ Case Rep 2015; 2015:bcr-2014-207822. [PMID: 25628323 DOI: 10.1136/bcr-2014-207822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pancreatic pseudocysts are known to extend beyond the confines of the pancreatic bed due to the digestive nature of enzyme rich pancreatic fluid. Extension of a pseudocyst beyond the retroperitoneum, along the retrofascial plane within the psoas muscle is, however, unusual, with only a handful of cases described in the literature. We report a case of a 28-year-old man who presented with right lumbar pain and painful ipsilateral hip extension. Imaging findings revealed extension of the pseudocyst into psoas along with features of acute pancreatitis. The pseudocyst was drained percutaneously under image guidance, which led to resolution of symptoms.
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Affiliation(s)
- Yashant Aswani
- Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Priya Hira
- Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Liu XF, Zheng MW, Liu Y, Li N. Endoscopic ultrasound for treatment of infected pancreatic pseudocysts. Shijie Huaren Xiaohua Zazhi 2014; 22:3849-3852. [DOI: 10.11569/wcjd.v22.i25.3849] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the clinical effect of endoscopic ultrasound (EUS) in the treatment of infected pancreatic pseudocysts (PPs).
METHODS: Between January 2008 and December 2013, 25 patients were admitted to our center for infected PPs and underwent EUS. The clinical data about therapies and recovery of the patients were analyzed.
RESULTS: All patients underwent EUS with transgastric stenting and BD drainage. One patient required laparoscopic surgery because therapeutic EUS was unsuccessful. Mean operative time was 48.3 min ± 27.6 min. Mean postoperative hospital stay was 8.4 d ± 3.7 d. The median follow-up period was 19.6 mo. No recurrence or other complications occurred.
CONCLUSION: Endoscopic ultrasound is a safe, effective and minimally invasive therapeutic method for infected PPs.
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Endoscopic transmural drainage of pancreatic pseudocysts: technical challenges in the resource poor setting. Case Rep Gastrointest Med 2013; 2013:942832. [PMID: 24377052 PMCID: PMC3860138 DOI: 10.1155/2013/942832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 12/23/2022] Open
Abstract
Although surgical drainage of pancreatic pseudocysts has been superseded by less invasive options, the requirement for specialized equipment, technical expertise, and consumables limits the options available in low resource settings.
We describe the challenges experienced during endoscopic transmural drainage in a low resource setting and the methods used to overcome these barriers. Despite operating in a low resource environment, endoscopic drainage of pancreatic pseudocysts can be incorporated into our armamentarium with minimal change to the existing hardware. Careful patient selection by a dedicated multidisciplinary team should be observed in order to achieve good outcomes.
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Qian D, Qin MF. Diagnosis and treatment of pancreatic pseudocysts by endoscopy and laparoscopy: Our experience with 56 cases. Shijie Huaren Xiaohua Zazhi 2013; 21:1992-1995. [DOI: 10.11569/wcjd.v21.i20.1992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the choice of minimally invasive treatments for pancreatic pseudocysts (PPC).
METHODS: Clinical data for 56 patients with PPC were retrospectively analyzed. The method of treatment was selected based on etiology, cyst formation time, adjacent organ position, and presence of intracystic infection or not.
RESULTS: Of 34 cases treated by endoscopic ultrasonography (EUS)-guided gastric or duodenal drainage, 33 were successful and 1 developed stent migration and underwent laparoscopic cyst drainage. Four cases were confirmed to have communication between cyst and the main pancreatic duct by ERCP, and two of them underwent pancreatic duct stent placement (ERPD). Of 9 cases undergoing laparoscopic cyst-jejunum Roux-en-Y anastomosis, 7 were successful and 2 were converted to open surgery. Four cases underwent laparoscopic cyst excision because cyst was too small and could not be distinguished from pancreatic cystadenoma preoperatively, and one patient developed postoperative pancreatic leakage. Four patients underwent CT-guided puncture and external drainage of cyst.
CONCLUSION: Treatments for PPC are diverse, and selection of appropriate treatment based on the patient's situation is key to the treatment of PPC. With the development of endoscopic and laparoscopic technologies, traditional treatment methods will be gradually replaced by minimally invasive treatments.
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