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Abera MT, Damtew HD, Yaynishet YA, Adela AY. Unusual Configuration of a Giant Trans-Spatial Pancreatic Pseudocyst with Spontaneous Shrinkage: A Rare Case Report. Int Med Case Rep J 2024; 17:281-287. [PMID: 38596401 PMCID: PMC11001558 DOI: 10.2147/imcrj.s458492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024] Open
Abstract
Pancreatic pseudocysts are benign lesions that typically originate within the pancreatic parenchyma, or peripancreatic tissue. They commonly occur following recurrent episodes of pancreatitis or trauma. In this article, we present a case of a giant pancreatic pseudocyst with unusual trans-spatial extensions and spontaneous size decrement in a 40-year-old male patient with a history of alcohol abuse. He presented with chronic epigastric pain, and a physical examination showed only mild abdominal tenderness. Initial computed tomography showed a giant (18.4cm in its largest axis) pancreatic pseudocyst with left subdiaphragmatic and gastrohepatic extensions and concurrent splenic cysts. On follow-up ultrasound, the pseudocyst showed a significant spontaneous size decrement to less than half of its initial size. The giant size and trans-spatial characteristics of the pseudocyst, along with a relatively benign symptomatology and subsequent spontaneous shrinkage, constitute unique aspects of this case.
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Affiliation(s)
| | | | | | - Amanuel Yegnanew Adela
- Department of Radiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Radiology, University of Gondar, Gondar, Ethiopia
- Ethiopian Federal Police Commission Referral Hospital, Addis Ababa, Ethiopia
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Barka M, Rguez A, Ben Cheikh Y, Chaouch MA, Jarrar MS, Ben Abdessalem Z, Hamila F, Youssef S. A case report of gastroduodenal artery pseudoaneurysm and giant pancreatic pseudocyst following acute pancreatitis revealed by obstructive jaundice. SAGE Open Med Case Rep 2023; 11:2050313X231188885. [PMID: 37529080 PMCID: PMC10387759 DOI: 10.1177/2050313x231188885] [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: 04/17/2022] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Acute necrotic pancreatitis is an emergency of evolution and is often unpredictable because of the potentially life-threatening complications it can cause. We report a unique case of a 56-year-old woman hospitalized for acute necrotic pancreatitis. The evolution of the latter was characterized by the occurrence of two very rare complications, of which the clinical presentations were atypical. The first complication was a gastroduodenal pseudoaneurysm compressing the main biliary tract and causing obstructive jaundice, which evolved well following percutaneous embolization. The second complication was a giant 20 cm pancreatic pseudocyst revealed by obstructive jaundice secondary to biliary compression, which progressed well following surgical treatment.
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Affiliation(s)
- Malek Barka
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Arib Rguez
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Yasser Ben Cheikh
- Department of Radiology, Sahloul University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mohamed Ali Chaouch
- Department of General and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Mohamed Salah Jarrar
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Zied Ben Abdessalem
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Fehmi Hamila
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sabri Youssef
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
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Nalwa HS, Lanka SP, Mederos R. Giant Pseudocyst of the Pancreas: A Case Report. Cureus 2022; 14:e29456. [PMID: 36299965 PMCID: PMC9587752 DOI: 10.7759/cureus.29456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/05/2022] Open
Abstract
Pancreatic cysts are usually asymptomatic over 70% of the time. They can be benign or malignant. Enhanced imaging modalities and increased usage of routine imaging have increased the identification of pancreatic cysts. If symptomatic, abdominal pain or back pain, unexplained weight loss, jaundice, steatorrhea or palpable mass are usually the presenting complaints. Pancreatic cysts are typically assessed by cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI). In this article, we present a case of a 33-year-old female with a recurrent large pancreatic pseudocyst, initially measured 15.8 cm x 14 cm x 14 cm, who was subsequently admitted to our unit and managed successfully. After undergoing diagnostic laparoscopy, exploratory laparotomy, and pancreatic cystogastrostomy, the pseudocyst shrunk to 8 cm x 6 cm over 13 weeks. It is rare to come across a pseudocyst of such large dimensions. Despite its large size, the patient presented with vague abdominal pain as the only chief complaint. The unusual presentation of symptoms and the enormous size of the pseudocyst make this a unique case. Managing giant pancreatic pseudocysts can be complex, as seen in this scenario by the multiple approaches attempted to treat the pseudocyst.
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Wu H, Ma K, Liao B, Ji T, Zhang S, Cao T. Comparative Analysis of Early Clinical Features and Complications of Different Types of Acute Pancreatitis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3771610. [PMID: 35795856 PMCID: PMC9252761 DOI: 10.1155/2022/3771610] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022]
Abstract
Background Acute pancreatitis (AP) is a common surgical acute abdomen. Different kinds of pancreatitis may have different pathophysiological characteristics each other. The objective of this research was to investigate the early clinical features and complications of different types of acute pancreatitis. Methods 787 AP patients admitted in the Huadu District People's Hospital of Guangzhou during January 2009 and December 2019 were analyzed retrospectively. Among 787 AP patients, 520 (66.1%) were biliary AP (group I), 69 (8.7%) were alcoholic AP (group II), and 198 (25.2%) were hypertriglyceridemic AP (group III). According to the local and systemic complications and mortality in the early stage, we compared and analyzed the clinical characteristics and prognosis of different types of pancreatitis. Results Mild acute pancreatitis accounted for the highest proportion (79.4%) in group I, while moderately severe acute pancreatitis in group II (36.2%) and severe acute pancreatitis in group III (62.6%). In terms of severity score of the pancreatitis, the average scores of BISAP, Ranson, APACHE-II, and MCTSI of the patients in group III were the highest (p < 0.01). The incidence of acute peripancreatic fluid collection and infectious pancreatic necrosis was the highest in group III. The incidences of acute necrotic collection, pancreatic pseudocyst, and walled-off necrosis in group III were significantly higher than those in the other two groups (p < 0.01). The incidences of systemic inflammatory response syndrome, sepsis, multiple organ failure, intra-abdominal hypertension, and mortality were highest in group III. Conclusions There is an upward trend of the incidence rate of hypertriglyceridemic AP in recent years; it has been gradually developed into the second type of acute pancreatitis which is second only to the acute biliary pancreatitis. It is worthy to pay more and more attentions to it due to the feature of its younger onset, high incidence of complications, and high mortality.
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Affiliation(s)
- Hongsheng Wu
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Keqiang Ma
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Biling Liao
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Tengfei Ji
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Shengmin Zhang
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
| | - Tiansheng Cao
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, 510800 Guangdong Province, China
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Billari WR, Roche D, DiGennaro JV, Shallcross MJ. Inpatient Management and Treatment of a Giant Pancreatic Pseudocyst: A Case Report. Cureus 2021; 13:e19990. [PMID: 34987890 PMCID: PMC8716118 DOI: 10.7759/cureus.19990] [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] [Accepted: 11/28/2021] [Indexed: 12/03/2022] Open
Abstract
Pancreatic pseudocyst formation is a common sequela of pancreatitis caused by alcohol use or gallstones. Giant pancreatic pseudocyst is an infrequently reported but serious complication of pancreatitis. Due to the large volume of pancreatic fluid containing active enzymes, giant pancreatic pseudocysts may require surgical intervention. We report a case of a giant pancreatic pseudocyst in a 56-year-old-female with a history of heavy alcohol use presenting with shortness of breath, general malaise, and dyspnea on exertion. Initial computed tomography (CT) scan demonstrated a giant pancreatic pseudocyst measuring up to 22 cm in the largest diameter. The patient was hospitalized, and an endoscopic cystogastrostomy was performed. Once the patient was stabilized, the cystogastrostomy stent was removed and replaced with a pigtail catheter. CT scan at three-month follow-up demonstrated no evidence of fluid re-accumulation. Due to the large size of giant pancreatic pseudocysts, drainage of the pseudocyst is the most appropriate treatment. There are different treatment modalities to achieve the goal of draining pseudocysts. One of the most commonly used treatments is an endoscopic ultrasound-guided cystogastrostomy, which this case highlights as an acceptable treatment option for giant pancreatic pseudocyst.
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Affiliation(s)
| | - Dwyer Roche
- Osteopathic Medicine, Edward Via Virginia College of Osteopathic Medicine, Blacksburg, USA
| | - Jeremy V DiGennaro
- Osteopathic Medicine, Edward Via Virginia College of Osteopathic Medicine, Blacksburg, USA
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Johnson TA, Vinayak A, Heo JY, Green TA. Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review. J Am Anim Hosp Assoc 2021; 58:96-104. [PMID: 34606594 DOI: 10.5326/jaaha-ms-6992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/11/2022]
Abstract
A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.
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Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature. Case Rep Gastrointest Med 2021; 2021:6610610. [PMID: 33868735 PMCID: PMC8035029 DOI: 10.1155/2021/6610610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table. Conclusion The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.
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Minghetti M, Lauro A, Pagano N, Vaccari S, D'Andrea V, Marino IR, Cervellera M, Tonini V. Two's a Charm: Endoscopic Therapy of Multiple Pancreatic Pseudocysts. Dig Dis Sci 2020; 65:66-70. [PMID: 31732908 DOI: 10.1007/s10620-019-05947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pancreatic pseudocysts commonly complicate acute pancreatitis. They can evolve either asymptomatically or with important symptoms. Treatment can be surgical, endoscopic, or percutaneous. The authors present a case report of a 78-year-old man who developed symptoms of an acute abdomen during hospitalization. A CT scan showed two pancreatic pseudocysts (diameters 10 cm and 7.5 cm) that were successfully drained endoscopically. Multiple pancreatic pseudocysts can be treated successfully via an endoscopic approach.
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Affiliation(s)
- M Minghetti
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy.
| | - N Pagano
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
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Endoscopic Management of Giant Walled-Off Pancreatic Necrosis With a High Risk of Bleeding. ACG Case Rep J 2019; 6:e00199. [PMID: 31737728 PMCID: PMC6791649 DOI: 10.14309/crj.0000000000000199] [Citation(s) in RCA: 2] [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: 05/06/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022] Open
Abstract
Walled-off pancreatic necrosis (WOPN) is one of the late complications of acute pancreatitis. We present a 37-year-old man who developed a large WOPN 6 weeks after treatment of severe complicated pancreatitis. Imaging studies revealed a necrotic retroperitoneal fluid collection measuring 27 × 12 × 27 cm with large crossing blood vessels. Cystogastrostomy was performed using a lumen-apposing metal stent. He underwent multiple necrosectomies with significant improvement in the cyst size. Bleeding is a major complication of direct endoscopic necrosectomy; hence, specific imaging and a careful approach should be taken into consideration, especially in WOPN with a high risk of bleeding.
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