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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.
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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
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2
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Xie J, Chen W, Liu H. Transpapillary pancreatic duct stenting in the treatment of acute severe pancreatitis complicated by pancreatic pseudocyst compressing the portal vein leading to local portal hypertension. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:378-380. [PMID: 37771282 DOI: 10.17235/reed.2023.9930/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
A 52-year-old male diagnosed with severe acute pancreatitis developed persistent abdominal distension and intermittent emesis six weeks after treatment. Computed tomography (CT) showed that the shape of the pancreas was not clear, and a pseudocyst (11.2*6.6 cm) existed in the tail of the pancreas, which compressed the portal vein and led to local portal hypertension. A transpapillary pancreatic duct stent (7F*9 cm) was successfully placed for drainage of fluid collection despite pancreatic duct obstruction, with one end into the pseudocyst cavity and the other into the duodenum. Duodenoscope observed outflow of the fluid collection immediately. Four days after the surgery, CT scan validated the location of the pancreatic duct stent, and the pancreatic pseudocyst was smaller than before. Another week later, the pancreatic pseudocyst nearly disappeared. No significant esophagogastric varix was observed by gastroscope, indicating a regression of local portal hypertension. The patient resumed eating normally, did not complain of vomiting, and was discharged from our hospital.
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Affiliation(s)
- Jun Xie
- Hepatobiliary Surgery, Daping Hospital. Army Medical University
| | - Wei Chen
- Hepatobiliary Surgery, Daping Hospital. Army Medical University, China
| | - Hongming Liu
- Hepatobiliary Surgery, Daping Hospital. Army Medical University, China
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3
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Serafin M, Kluszczyk P, Maślanka S, Kowalczyk T, Jabłońska B, Mrowiec S. Hemorrhagic Cysts in the Pancreas: Risk Factors, Treatment, and Outcomes - Insights from a Single-Center Study. Med Sci Monit 2024; 30:e941955. [PMID: 38872280 PMCID: PMC11184984 DOI: 10.12659/msm.941955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/20/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Hemorrhagic cysts are rarely discussed subtypes of pancreatic pseudocysts that occur in about 10% of these cases. They are caused by erosion of the walls of neighboring vessels by extravasated proteolytic pancreatic enzymes. A retrospective analysis was performed to clinically characterize risk factors, treatment, and outcome in patients with hemorrhagic cysts of the pancreas. MATERIAL AND METHODS The retrospective study included patients from the Department of Digestive Tract Surgery in Katowice, Poland, who were treated surgically for a pancreatic hemorrhagic cyst from January 2016 to November 2022. We gathered and assessed data on cyst etiology, symptoms, imaging examinations, risk factors, time, type, and complications of surgery. RESULTS The main symptom was abdominal pain, noted in 5 (62.5%) patients. The most common etiology of cyst was acute pancreatitis, which occurred in 5 patients (62.5%). The most common localization was the tail of pancreas, found in 3 patients (36.5%). The largest dimension of the cyst was 98±68 (30-200) mm. Every patient needed surgical intervention. Patients underwent distal pancreatectomy (n=3) or marsupialization (n=5). One (12.5%) postoperative complication was observed, while mortality was 0%. CONCLUSIONS Hemorrhagic cyst is a life-threatening complication of pancreatitis requiring immediate treatment. In most cases, open surgery is the treatment of choice. Despite the continuous development of minimally invasive techniques, surgical treatment remains the only effective treatment method. Depending on the cyst localization and technical possibilities, pancreatectomy or marsupialization can be applied, and both of them have low complication and mortality rates.
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Affiliation(s)
- Michał Serafin
- Students’ Scientific Society, Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Paulina Kluszczyk
- Students’ Scientific Society, Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Sebastian Maślanka
- Students’ Scientific Society, Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Tomasz Kowalczyk
- Students’ Scientific Society, Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Sławomir Mrowiec
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
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Ali MS, Cheleng A, Behera P, Sahoo MR. A Gastrointestinal Stromal Tumor (GIST) and a Pseudocyst of the Pancreas: A Peculiar Case of Both Co-existing in the Same Patient. Cureus 2024; 16:e61642. [PMID: 38966474 PMCID: PMC11223449 DOI: 10.7759/cureus.61642] [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] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract, typically originating from the interstitial cells of Cajal. The clinical presentations are variable according to their size and shape but rarely present as a palpable abdominal mass. Pancreatic pseudocysts are common complications of chronic pancreatitis characterized by fluid collections surrounded by a non-epithelialized wall of fibrous and granulation tissue. Patients may present with non-specific symptoms like abdominal pain, nausea, and vomiting and they generally have a history of acute pancreatitis. Small pseudocysts often resolve spontaneously, but larger ones often become symptomatic and may lead to complications. It is rare to find both a GIST of the stomach and a pseudocyst of the pancreas in the same patient. We present a unique case of a giant GIST and a pancreatic pseudocyst in a 72-year-old male who was experiencing abdominal pain and distension. Imaging revealed a massive lesion originating from the posterior gastric wall, which resembled a pseudocyst, along with a distinct cystic lesion adjacent to the pancreatic body. During surgical exploration, a complex interplay of both pathologies was discovered, requiring a comprehensive resection approach. The successful outcome highlights the importance of careful evaluation and personalized management in such rare cases.
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Affiliation(s)
- Manwar S Ali
- Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Ankur Cheleng
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Pravanjan Behera
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Manash R Sahoo
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Paramythiotis D, Karlafti E, Kollatou AS, Simou T, Mavropoulou X, Psoma E, Rafailidis V, Papachristodoulou A, Pyrrou N, Ioannidis A, Panidis S, Michalopoulos A. Pancreatolithiasis: Does Management Depend on Clinical Manifestations? AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942725. [PMID: 38615191 PMCID: PMC11025692 DOI: 10.12659/ajcr.942725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/29/2024] [Accepted: 02/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Pancreatic calculi (PC) or pancreatolithiasis refers to the presence of stones in the main pancreatic duct (MPD), side branches, or parenchyma of the pancreas. It is highly associated with chronic pancreatitis (CP), and is present in 50-90% of those patients. The stone formation can be attributed to a diversity of factors, all of them leading to obstruction in the duct, hypertension of its distal part, increased intraductal and parenchymal pressure, and inflammation, causing the standard symptom, epigastric pain. Immediate restoration of pancreatic secretion flow is of utmost importance and can be achieved with both endoscopic and surgical techniques. Endoscopic techniques include endoscopic retrograde cholangiopancreatography (ERCP) combined, if possible, with extracorporeal shock wave lithotripsy (ESWL), while surgical techniques consist of drainage and resection procedures. The choice of treatment for PC depends on the location, size, and number of stones, and the existence of other complications. CASE REPORT We present 2 cases that were diagnosed with PC, in which clinical symptoms, laboratory results, and imaging examinations were different, suggesting the variety of manifestations pancreatolithiasis can cause. Each patient was treated differently, according to their clinical situation and the presence or absence of complications. Both patients were discharged and fully recovered. CONCLUSIONS The management of pancreatolithiasis can be demanding in some cases, mostly when there are complications. The purpose of this case report is to indicate the importance of personalized treatment for each patient, as different approaches to the same medical condition should be easily identified and successfully treated.
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Affiliation(s)
- Daniel Paramythiotis
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Department of Emergency, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Sevasti Kollatou
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Simou
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xanthippi Mavropoulou
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Psoma
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Papachristodoulou
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoletta Pyrrou
- Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristeidis Ioannidis
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Panidis
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1 Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
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6
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Olson CG, Karime C, Chirila R. 34-Year-Old Man With Sudden Epigastric Abdominal Pain. Mayo Clin Proc 2024; 99:649-654. [PMID: 38323944 DOI: 10.1016/j.mayocp.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Caroline G Olson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Christian Karime
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Razvan Chirila
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Jacksonville, FL
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Chhabra M, Gupta P, Shah J, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U, Kochhar R. Imaging Diagnosis and Management of Fistulas in Pancreatitis. Dig Dis Sci 2024; 69:335-348. [PMID: 38114791 DOI: 10.1007/s10620-023-08173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/27/2023] [Indexed: 12/21/2023]
Abstract
Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous drains or external wound (following surgery) due to the communication of the peripancreatic collection with the main pancreatic duct (MPD). Internal pancreatic fistulas include communication of the pancreatic duct (directly or via intervening collection) with the pleura, pericardium, mediastinum, peritoneal cavity, or gastrointestinal tract. Cross-sectional imaging plays an essential role in the management of pancreatic fistulas. With the help of multiplanar imaging, fistulous tracts can be delineated clearly. Thin computed tomography sections and magnetic resonance cholangiopancreatography images may demonstrate the communication between MPD and pancreatic fluid collections or body cavities. Endoscopic retrograde cholangiography (ERCP) is diagnostic as well as therapeutic. In this review, we discuss the imaging diagnosis and management of various types of pancreatic fistulas with the aim to sensitize radiologists to timely diagnosis of this critical complication of pancreatitis.
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Affiliation(s)
- Manika Chhabra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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8
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Shrestha G, Rajbhandari S, Karki B, Bashya B, Ghimire B. Intrahepatic pancreatic pseudocyst (wayward cyst): A rare presentation of traumatic pancreatitis. Int J Surg Case Rep 2024; 114:109125. [PMID: 38100928 PMCID: PMC10762353 DOI: 10.1016/j.ijscr.2023.109125] [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: 11/09/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Cystic lesions in the liver are commonly encountered space-occupying lesions having various etiologies such as simple cysts, malignancies, hydatid cysts, and pancreatic pseudocysts. CASE PRESENTATION An eight-year-old girl initially presented with acute abdominal pain, fever, and a cystic lesion in the upper abdomen. Surgical intervention was performed based on an initial diagnosis of an inflammatory cyst. Later, she developed pleural effusion. Further investigations, unveiled a cystic mass arising from the head of the pancreas, and a pancreatico-pleural fistula. Retrospective analysis revealed a history of trauma that started her illness course. Conservative management involving intercostal tube drainage and octreotide infusion resulted in a favorable outcome. DISCUSSION Pancreatic pseudocyst is typically results from pancreatitis or trauma but in rare cases, they can have extended to unusual locations such as the liver. This case highlights the varied presentations and complex interplay of symptoms associated with intrahepatic pseudocysts. The initial oversight of trauma in the patient's history underscore the importance of thorough history-taking for an accurate diagnosis. The complexity of this case emphasize the necessity of a multidisciplinary approach in managing such atypical presentations. CONCLUSION Intrahepatic pseudocysts, especially those resulting from post-traumatic pancreatic pseudocyst, are uncommon and are not typically included in the differential diagnosis of liver lesions. This case highlights the significance of identifying unusual presentation and thoroughly investigating the patient's medical history to make an accurate diagnosis. A multidisciplinary approach is essential for effective patient management in these complex cases.
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Affiliation(s)
| | | | - Badal Karki
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Bibhav Bashya
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Bikal Ghimire
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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9
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Bathobakae L, Ozgur SS, Aiken A, Mahmoud A, Escobar J, Melki G, Cavanagh Y, Baddoura W. Sinistral Portal Hypertension Due to a Pancreatic Pseudocyst: A Rare Cause of Upper Gastrointestinal Bleeding. J Investig Med High Impact Case Rep 2024; 12:23247096241231644. [PMID: 38347706 PMCID: PMC10865932 DOI: 10.1177/23247096241231644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
Sinistral portal hypertension (SPH), also known as segmental portal hypertension, is a complication of pancreatic disorders and an extremely rare cause of upper gastrointestinal (GI) bleeding. SPH is observed in patients without cirrhosis and arises from splenic vein thrombosis. Unmitigated backflow of blood may cause gastric venous congestion and ultimately GI hemorrhage. Herein, we report a rare case of massive hematemesis due to SPH in a male patient with a history of chronic pancreatitis and pancreatic pseudocyst. Our patient was successfully treated with endoscopic necrosectomy followed by open splenectomy, distal pancreatectomy, and partial gastric resection.
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Affiliation(s)
- Lefika Bathobakae
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Sacide S. Ozgur
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Arielle Aiken
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Anas Mahmoud
- Internal Medicine Department, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Jessica Escobar
- Medical Library Services, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Gabriel Melki
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Yana Cavanagh
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Walid Baddoura
- Gastroenterology & Hepatology, St. Joseph’s University Medical Center, Paterson, NJ, USA
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10
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Elfert K, Chamay S, Santos LD, Mohamed M, Beran A, Jaber F, Abosheaishaa H, Nayudu S, Ho S. Increasing trend of endoscopic drainage utilization for the management of pancreatic pseudocyst: insights from a nationwide database. Clin Endosc 2024; 57:105-111. [PMID: 37536745 PMCID: PMC10834290 DOI: 10.5946/ce.2023.054] [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] [Received: 02/16/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND/AIMS The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed. METHODS The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes. RESULTS Endoscopic drainage was the most commonly used drainage modality in 2018-2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001). CONCLUSION Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs.
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Affiliation(s)
- Khaled Elfert
- Department of Internal Medicine, SBH Health System, New York, NY, USA
| | - Salomon Chamay
- Department of Internal Medicine, SBH Health System, New York, NY, USA
| | - Lamin Dos Santos
- Department of Internal Medicine, SBH Health System, New York, NY, USA
| | - Mouhand Mohamed
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Hazem Abosheaishaa
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens, NY, USA
| | - Suresh Nayudu
- Division of Gastroenterology, SBH Health System, New York, NY, USA
| | - Sammy Ho
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Raza MM, Logan MR, Stuart DL, Patel H. Atypical Presentation of a Preexisting Pancreatic Pseudocyst with Glucagon-Like Peptide-1 Agonist as a Possible Trigger for Exacerbation: A Case Report. Cureus 2023; 15:e47559. [PMID: 38022107 PMCID: PMC10665757 DOI: 10.7759/cureus.47559] [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] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Pancreatitis encompasses pancreatic tissue inflammation due to enzymatic autodigestion, leading to complications such as pancreatic pseudocysts. This report details a case in which the administration of glucagon-like peptide-1 (GLP-1) agonists rendered a regressing, asymptomatic pseudocyst symptomatic. We posit that, absent other triggers, GLP-1 agonists might exacerbate pseudocysts. This emphasizes timely diagnosis and proper management. Our investigation delves into patient-specific nuances, potential mechanistic insights, the need to study this phenomenon among a broader cohort, alternative pathologies, long-term consequences, and clinical ramifications in response to a shifting pseudocyst behavior.
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Affiliation(s)
- Murtajiz M Raza
- Research, Avalon University School of Medicine, Willemstad, CUW
| | - Matthew R Logan
- Research, Avalon University School of Medicine, Willemstad, CUW
| | - David L Stuart
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
| | - Hrishi Patel
- Internal Medicine, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
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12
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Li M, Zhou S, Chen Y, Zhao J, Wu C, Li M. Huge water-balloons in the belly: multiple pancreatic pseudocysts in systemic lupus erythematosus. Rheumatology (Oxford) 2023; 62:e286-e287. [PMID: 36864625 DOI: 10.1093/rheumatology/kead095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Affiliation(s)
- Mucong Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shuang Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yang Chen
- Department of Gastroenterology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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13
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Skipper MT, Albertsen BK, Schmiegelow K, Andrés-Jensen L. Long-term effects of asparaginase-associated pancreatitis. Pediatr Blood Cancer 2023:e30528. [PMID: 37376950 DOI: 10.1002/pbc.30528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Pancreatitis is a common and severe toxicity that occurs during asparaginase treatment for acute lymphoblastic leukemia, and has received increasing attention during the last decades. However, no consensus regarding follow-up exists. In this commentary, we highlight potential long-term health-related effects following asparaginase-associated pancreatitis, thereby providing clinicians with a framework when following these patients during and after cessation of therapy.
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Affiliation(s)
- Mette Tiedemann Skipper
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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14
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Kalsi H, Jue TL, Pannala R. Arterial Pseudoaneurysm Mimicking a Mural Nodule Within a Pancreatic Cyst. ACG Case Rep J 2023; 10:e01080. [PMID: 37389193 PMCID: PMC10306426 DOI: 10.14309/crj.0000000000001080] [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: 09/16/2022] [Accepted: 05/24/2023] [Indexed: 07/01/2023] Open
Abstract
Pancreatic cysts with high-risk characteristics are at increased risk of harboring high-grade dysplasia or pancreatic cancer. Endoscopic ultrasound may clarify the nature of the cystic lesion and its malignant potential. A mural nodule found through endoscopic ultrasound within a cyst may represent malignancy and require fine-needle aspiration. Pancreatic pseudocysts are benign walled-off fluid collections that form in the setting of pancreatitis and may be difficult to differentiate from neoplastic cysts. Pseudoaneurysms form when pancreatitis inflammation damages vessel walls and can cause fatal hemorrhage. We present a pancreatic pseudocyst with pseudoaneurysm mimicking a neoplastic cyst with a mural nodule.
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Affiliation(s)
| | - Terry L. Jue
- Department of Gastroenterology & Hepatology, Mayo Clinic, AZ
| | - Rahul Pannala
- Department of Gastroenterology & Hepatology, Mayo Clinic, AZ
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15
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Kaushik K, Pratap A, Naik B, Datta Sai Subramanyam A, Ansari MA. Intact Excision of a Mesenteric Pseudocyst. Cureus 2023; 15:e40615. [PMID: 37476128 PMCID: PMC10354564 DOI: 10.7759/cureus.40615] [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] [Accepted: 06/18/2023] [Indexed: 07/22/2023] Open
Abstract
Mesenteric cysts are detected in all age groups with almost equal incidence in both genders. Although a rare abdominal growth, it is commonly found in the fifth to seventh decades of life. These are mostly small (asymptomatic) with a 3% chance of malignant transformation. With the increase in the size of the cyst, nonspecific complaints of abdominal pain, distention, discomfort, nausea, vomiting, flatulence, constipation, or diarrhea may develop. Owing to the varied presentation and lack of pathognomonic clinical, laboratory, or imaging findings, these are difficult to diagnose. The subtype mesenteric pseudocyst is even rarer with a reported incidence of less than 1 out of 250,000 hospital admissions and can be found anywhere along the mesentery from the duodenum to the rectum. Etiology is either traumatic or infectious. Incidental diagnosis during abdominal imaging or laparotomy is common. However, it warrants immediate surgical intervention when infected or ruptured. Complete excision of the cyst is the treatment of choice. Here, we report an interesting case of a middle-aged gentleman who had been repeatedly evaluated for a tense abdomen with exudative ascites. Following decompression, he presented to us with a large obliquely mobile mass in the abdomen. The diagnosis was made by clinical and radiological findings and confirmed by histopathological examination of the intact, excised specimen post-laparotomy.
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Affiliation(s)
- Kumar Kaushik
- General Surgery, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | - Arvind Pratap
- General Surgery, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | - Bitan Naik
- Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
| | | | - Mumtaz A Ansari
- General Surgery, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, IND
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16
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Nohomovich B, Shah A, Hughes N. Severe, Complicated Pancreatitis With an Unclear Etiology. Cureus 2023; 15:e39011. [PMID: 37323321 PMCID: PMC10264160 DOI: 10.7759/cureus.39011] [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] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Acute pancreatitis is an inflammatory process. There can be many causes of pancreatitis, which include alcohol or gallstones but can also be due to hypercalcemia, infections, or hypertriglyceridemia. Most cases of pancreatitis are mild and without complications. Severe cases of pancreatitis can cause complications, including organ failure. Pseudocysts are a rare complication of pancreatitis and may require management. We present a patient with severe acute pancreatitis with organ failure admitted to the intensive care unit, stabilized, and required subsequent management of a pseudocyst with cystogastrostomy with a lumen-apposing metal stent. The patient subsequently improved and is doing well today. Herein, we present an acute severe pancreatitis case report with an extensive workup complicated by pseudocyst development. We review pancreatitis causes, including rare causes and management.
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Affiliation(s)
- Brian Nohomovich
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Ali Shah
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Neil Hughes
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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17
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Chaudhry H, Sohal A, Bains K, Dhaliwal A, Dukovic D, Singla P, Sharma R, Kohli I, Chintanaboina J. Incidence and factors associated with portal vein thrombosis in patients with acute pancreatitis: A United States national retrospective study. Pancreatology 2023:S1424-3903(23)00072-8. [PMID: 37012176 DOI: 10.1016/j.pan.2023.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND/OBJECTIVE Portal vein thrombosis (PVT) is a well-known complication in patients with acute pancreatitis (AP). Limited data exist on the incidence and factors of PVT in patients with AP. We investigate the incidence and clinical predictors of PVT in AP. METHODS We queried the 2016-2019 National Inpatient Sample database to identify patients with AP. Patients with chronic pancreatitis or pancreatic cancer were excluded. We studied demographics, comorbidities, complications, and interventions in these patients and stratified the results by the presence of PVT. A multivariate regression model was used to identify factors associated with PVT in patients with AP. We also assessed the mortality and resource utilization in patients with PVT and AP. RESULTS Of the 1,386,389 adult patients admitted with AP, 11,135 (0.8%) patients had PVT. Women had a 15% lower risk of developing PVT (aOR-0.85, p < 0.001). There was no significant difference between the age groups in the risk of developing PVT. Hispanic patients had the lowest risk of PVT (aOR-0.74, p < 0.001). PVT was associated with pancreatic pseudocyst (aOR-4.15, p < 0.001), bacteremia (aOR-2.66, p < 0.001), sepsis (aOR-1.55, p < 0.001), shock (aOR-1.68, p < 0.001) and ileus (aOR-1.38, p < 0.001). A higher incidence of in-hospital mortality and ICU admissions was also noted in patients with PVT and AP. CONCLUSION This study demonstrated a significant association between PVT and factors such as pancreatic pseudocyst, bacteremia, and ileus in patients with AP.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, California, USA
| | - Aalam Sohal
- Liver Institute Northwest, Seattle, WA, USA.
| | - Kanwal Bains
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | | | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, NewYork, NY, USA
| | - Jayakrishna Chintanaboina
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, California, USA
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18
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Gupta A, Chennatt JJ, Mandal C, Gupta J, Krishnasamy S, Bose B, Solanki P, H S, Singh SK, Gupta S. Approach to Cystic Lesions of the Pancreas: Review of Literature. Cureus 2023; 15:e36827. [PMID: 37123688 PMCID: PMC10139841 DOI: 10.7759/cureus.36827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Pancreatic cystic lesions (PCL) have a wide range of demographical, clinical, morphological and histological characteristics. The distinction between these lesions is of paramount importance due to the risk of malignancy in specific categories of PCL. Considering the malignant potential for pancreatic cystic neoplasm (PCN) lesions, guidelines have been made to balance unnecessary treatment and manage the progression to malignancy. Various surgical procedures can be done for PCN depending on the location and size of the cyst; pancreatoduodenectomy is done for PCN located in the head of the uncinate process, whereas distal pancreatectomy is done for PCN in the body or tail. In the neck and proximal body of the pancreas, less extensive resections such as central pancreatectomy can be performed. Active surveillance of PCN is typically offered to asymptomatic PCNs of subtype intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) without any concerning features. In recent years, numerous guidelines have been created to augment PCN diagnosis, classification and management. Despite this, the management of PCNs remains complex. Thus, discussions with multidisciplinary teams involving surgeons, gastroenterologists, pathologists, and radiologists are required to ensure optimum care for the patient.
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19
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Chtourou MF, Beji H, Zribi S, Kallel Y, Bouassida M, Touinsi H. Spontaneous rupture of an infected pseudocyst of the pancreas: A case report. Int J Surg Case Rep 2023; 105:107987. [PMID: 36934651 PMCID: PMC10033984 DOI: 10.1016/j.ijscr.2023.107987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A pancreatic pseudocyst is a known complication of acute and chronic pancreatitis. A pseudocyst rupture into the abdomen causes peritonitis, which can be fatal if surgical treatment is delayed. Here in we report the case of a 46-year-old woman presenting with a pancreatic pseudocyst doubly complicated with infection and rupture causing sepsis shock. CASE PRESENTATION A 46 year-old-woman, with a history of chronic pancreatitis four years prior complicated with a pancreatic pseudocyst of 3 cm, presented to our emergency department with clinical signs of generalized peritonitis. After a brief resuscitation, we performed a midline laparotomy. It showed purulent peritonitis due to a rupture of an infected pseudocyst of the pancreas. We performed an abundant peritoneal toilet with drainage. The patient was discharged after 25 days. In the one month follow-up, there were no unfavourable outcomes. CLINICAL DISCUSSION In presence of ruptured and infected pancreatic pseudocyst, surgical treatment should be performed as soon as possible after brief resuscitation. Laparotomy is the gold standard treatment. The main objective of surgical treatment is to perform abundant peritoneal toilet with large external drainage. In our case, the pancreatic pseudocyst didn't communicate with the Wirsung duct allowing us to withdraw the drainage. Otherwise, the drainage should be retained longer to treat the pancreatic leakage. CONCLUSION Rupture and infection of pancreatic pseudocysts is a rare situation. Diagnosis is assessed via computed tomography scan. Emergency laparotomy should be performed timely to make the peritoneal toilet and drain the pancreatic pseudocyst.
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Affiliation(s)
- Mohamed Fadhel Chtourou
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hazem Beji
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Slim Zribi
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Yassine Kallel
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mahdi Bouassida
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hassen Touinsi
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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20
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Suleman M, Tadayo J, Tendwa I, Amsi P, Tsandiraki J, Lodhia J. Pancreatic pseudocyst as a cause for gastric outlet obstruction. Clin Case Rep 2023; 11:e7122. [PMID: 36941834 PMCID: PMC10023671 DOI: 10.1002/ccr3.7122] [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: 12/28/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/20/2023] Open
Abstract
The pancreatic pseudocyst contains pancreatic enzymes encapsulated by a non-epithelialized wall. They are rare in the pediatric population and are mostly a result of pancreatic trauma: extrinsic, or intrinsic. Management options include conservative or surgical, depending on the clinical signs and symptoms, and the size of the cyst.
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Affiliation(s)
- Mujaheed Suleman
- Department of General SurgeryKilimanjaro Christian Medical University CollegePO Box 3010MoshiTanzania
| | - Joshua Tadayo
- Department of General SurgeryKilimanjaro Christian Medical University CollegePO Box 3010MoshiTanzania
| | - Irene Tendwa
- Department of General SurgeryKilimanjaro Christian Medical University CollegePO Box 3010MoshiTanzania
| | - Patrick Amsi
- Department of PathologyKilimanjaro Christian Medical University CollegePO Box 3010MoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegePO Box 2240MoshiTanzania
| | - Justin Tsandiraki
- Department of General SurgeryKilimanjaro Christian Medical University CollegePO Box 3010MoshiTanzania
| | - Jay Lodhia
- Department of General SurgeryKilimanjaro Christian Medical University CollegePO Box 3010MoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegePO Box 2240MoshiTanzania
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21
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Horváth IL, Bunduc S, Hankó B, Kleiner D, Demcsák A, Szabó B, Hegyi P, Csupor D. No evidence for the benefit of PPIs in the treatment of acute pancreatitis: a systematic review and meta-analysis. Sci Rep 2023; 13:2791. [PMID: 36797320 PMCID: PMC9935541 DOI: 10.1038/s41598-023-29939-5] [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] [Received: 10/31/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Although current guidelines do not recommend the use of proton pump inhibitors (PPIs) in the standard of care of acute pancreatitis (AP), they are often prescribed in clinical practice, mainly for ulcer stress prophylaxis. In this systematic review and meta-analysis we evaluated the association between the use of PPIs in the management of AP and various clinical outcomes. We conducted the systematic research in six databases without restrictions on January 24th, 2022. We investigated adult patient with AP, who were treated with PPI compared to conventional therapy. The pooled odds ratios, mean differences, and corresponding 95% confidence intervals were calculated with random effect model. We included six RCTs and three cohort studies, consisting of 28,834 patients. We found a significant decrease in the rate of pancreatic pseudocyst formation in patients who received PPI treatment. PPI use was associated with a higher risk of GI bleeding, however this finding could be due to the patients' comorbid conditions. We found no significant difference in the rates of 7-day mortality, length of hospital stay, and acute respiratory distress syndrome between the groups. The available data on this topic are limited; therefore, further well designed RCTs are needed to evaluate the potential benefits and adverse effects of PPIs in AP.
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Affiliation(s)
- István László Horváth
- grid.11804.3c0000 0001 0942 9821Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary ,University Pharmacy Department of Pharmacy Administration, Hőgyes Endre utca 7-9, 1092 Budapest, Hungary
| | - Stefania Bunduc
- grid.11804.3c0000 0001 0942 9821Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary ,grid.11804.3c0000 0001 0942 9821Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross út 22-24, 1085 Budapest, Hungary ,grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, Dionisie Lupu Street 37, 020021 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Fundeni Clinical Institute, Fundeni Street 258, 022328 Bucharest, Romania
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Hőgyes Endre utca 7-9, 1092 Budapest, Hungary
| | - Dénes Kleiner
- grid.11804.3c0000 0001 0942 9821Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary ,University Pharmacy Department of Pharmacy Administration, Hőgyes Endre utca 7-9, 1092 Budapest, Hungary
| | - Alexandra Demcsák
- grid.19006.3e0000 0000 9632 6718Department of Surgery, University of California Los Angeles, 675 Charles E Young Dr. S MRL 2220, Los Angeles, CA 90095 USA
| | - Bence Szabó
- grid.11804.3c0000 0001 0942 9821Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary
| | - Péter Hegyi
- grid.11804.3c0000 0001 0942 9821Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary ,grid.11804.3c0000 0001 0942 9821Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross út 22-24, 1085 Budapest, Hungary ,grid.9679.10000 0001 0663 9479Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 7624 Pécs, Hungary
| | - Dezső Csupor
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary. .,Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 7624, Pécs, Hungary. .,Institute of Clinical Pharmacy, University of Szeged, Szikra utca 8, 6725, Szeged, Hungary.
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22
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Mark JD, Park T, Velez Quinones V, Isaac S. Rare extension of pancreatic pseudocyst with Mycobacterium abscessus into the iliopsoas muscle. BMJ Case Rep 2022; 15:e252777. [PMID: 36319038 PMCID: PMC9628508 DOI: 10.1136/bcr-2022-252777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pancreatic pseudocyst is a well-known complication of both acute and chronic pancreatitis. Although extension into other anatomical sites is common, extension into the retrofascial space causing an iliopsoas abscess is exceedingly rare. Although its low incidence creates a diagnostic challenge for clinicians, early diagnosis is essential to prevent significant complications and poor patient outcomes. We present a case of iliopsoas abscess with unusual culture fluid growth in the setting of acute on chronic pancreatitis secondary to extension of a pancreatic pseudocyst. We also offer a brief review of the literature and pathophysiology of the condition.
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Affiliation(s)
- Justin David Mark
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Travis Park
- Department of Internal Medicine, HCA Florida JFK Hospital, Atlantis, Florida, USA
| | | | - Shaun Isaac
- Department of Internal Medicine, HCA Florida JFK Hospital, Atlantis, Florida, USA
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23
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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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24
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Bell PD, Singhi AD. Integrating Molecular Analysis into the Pathologic Evaluation of Pancreatic Cysts. Surg Pathol Clin 2022; 15:455-468. [PMID: 36049828 DOI: 10.1016/j.path.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The development of cross-sectional imaging techniques has enhanced the detection of pancreatic cystic lesions (PCLs). PCLs are found in approximately 2% of the general population, often as incidentally detected lesions on computed tomography or MRI during the evaluation of other medical conditions. Broadly, PCLs are classified as mucinous or nonmucinous. Mucinous PCLs include mucinous cystic neoplasms and intraductal papillary mucinous neoplasms. Nonmucinous PCLs include pseudocysts, serous cystadenomas, solid pseudopapillary neoplasms, and cystic pancreatic neuroendocrine tumors, as well as cystic acinar cell carcinoma, cystic degeneration of pancreatic ductal adenocarcinoma, lymphoepithelial cyst, and others.
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Affiliation(s)
- Phoenix D Bell
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St. Pittbsurgh, PA 15213, USA.
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St. Pittbsurgh, PA 15213, USA
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25
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Sabir S, Peace S, Ho C, Oi K, Le K. Giant Hemorrhagic Pancreatic Pseudocyst: A Case Report and Guidelines for Care. Cureus 2022; 14:e28398. [PMID: 36171855 PMCID: PMC9508934 DOI: 10.7759/cureus.28398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Pancreatic pseudocysts are potential sequelae of acute or chronic pancreatitis. In some cases, enzymatic degradation of the lining between a pseudocyst and the splenic artery, or surrounding vessels, can occur, resulting in a hemorrhagic pancreatic pseudocyst. Very few of these hemorrhagic pseudocysts meet the criteria for giant pseudocysts. We discuss the case of a 30-year-old male patient with a history of alcohol abuse who presented to the hospital with a giant hemorrhagic pancreatic pseudocyst; he was admitted for expectant management and was subsequently discharged. This case report seeks to shed light on the dearth of similar cases.
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26
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Pancreatic Incidentaloma. J Clin Med 2022; 11:jcm11164648. [PMID: 36012893 PMCID: PMC9409921 DOI: 10.3390/jcm11164648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic incidentalomas (PIs) represent a clinical entity increasingly recognized due to advances in and easier access to imaging techniques. By definition, PIs should be detected during abdominal imaging performed for indications other than a pancreatic disease. They range from small cysts to invasive cancer. The incidental diagnosis of pancreatic cancer can contribute to early diagnosis and treatment. On the other hand, inadequate management of PIs may result in overtreatment and unneeded morbidity. Therefore, there is a strong need to evaluate the nature and clinical features of individual PIs. In this review, we summarize the major characteristics related to PIs and present suggestions for their management.
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27
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Son TQ, Hoc TH, Huong TT, Dinh NQ, Van Tuyen P. A ruptured pancreatic pseudocyst causes acute peritonitis with clinical characteristics of a gastrointestinal tract perforation. J Surg Case Rep 2022; 2022:rjac164. [PMID: 35665383 PMCID: PMC9154066 DOI: 10.1093/jscr/rjac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/14/2022] Open
Abstract
Intraperitoneal air in pancreatic pseudocysts is a rare complication that can jeopardize hemodynamic stability and requires emergency surgery. A 61-year-old man was admitted to our hospital after abdominal pain, vomiting and diarrhea. Computed tomography showed a hollow visceral perforation with intraperitoneal air and two pseudocysts close to the pancreas. The patient was transferred to the emergency operating room with symptoms of septic shock. We histopathologically diagnosed a ruptured pancreatic pseudocyst combined with an intracystic haemorrhage. We resected a portion of the pseudocyst wall using surface electrocautery inside the lumen, cholecystectomy and peritoneal toilet and maintained adequate external drainage. The patient was discharged on postoperative Day 12. The patient achieved relapse-free survival for 12 months postoperatively. Ruptured pancreatic pseudocysts with extraluminal gas are dangerous if effective medical interventions are not performed. Emergency surgery should be completed as soon as possible to drain the pancreatic cyst and cleanse the abdomen.
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Affiliation(s)
- Tran Que Son
- Department of Surgery, Hanoi Medical University, No. 1 Ton That Tung, Dong Da District, Hanoi, Vietnam
| | - Tran Hieu Hoc
- Department of Surgery, Hanoi Medical University, No. 1 Ton That Tung, Dong Da District, Hanoi, Vietnam
| | - Tran Thu Huong
- Department of Pharmacy, Bachmai Hospital, 78 Giaiphong Road, Dong Da District, Hanoi, Vietnam
| | - Ngo Quang Dinh
- Radiology Center - Bach Mai Hospital, 78 Giaiphong Road, Dong Da District, Hanoi, Vietnam
| | - Pham Van Tuyen
- Pathology Center - Bach Mai Hospital, 78 Giaiphong Road, Dong Da District, Hanoi, Vietnam
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Khan MA, Almas T, Ullah M, Alkhattab M, Shaikh F, Shaikh S, Bagwe I, Antony M, Khedro T, Nagarajan VR, Ramjohn J, Alsufyani R, Almubarak D, Al-Awaid AH, Alsufyani M, Nagarajan DR, Khan MO, Huang H, Oruk M, Samy A, Alqallaf N, Shafi A, Adeel A, Khan MK. Candida glabrata infection of a pancreatic pseudocyst in a COVID-19 patient: A case report and review of the literature. Ann Med Surg (Lond) 2022; 77:103648. [PMID: 35638027 PMCID: PMC9142617 DOI: 10.1016/j.amsu.2022.103648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Pancreatic pseudocysts remain a feared complication of acute or chronic pancreatitis and are often characterized by collections of fluids due to underlying damage to the pancreatic ducts, culminating in a walled-off region bereft of an epithelial layer but surrounded by granulation tissue. While fungal infections of pancreatic pseudocysts are rarely encountered, candida albicans remains the most frequently implicated organism. Case presentation A 55-year-old male presented with pain in the left-hypochondriac region, accompanied by non-bilious emesis and nausea. Interestingly, the patient also tested positive for a COVID-19 infection. Investigative workup divulged enhancing pancreatic walls with a radiologic impression consistent with a pancreatic pseudocyst. An ultrasound-guided external drainage was performed; the drainage was conducted unremarkably, with the resultant fluid collection revealing the presence of Candida Glabrata. The patient was commenced on antifungal therapy and continues to do well to date. Discussion Infectious ailments of pancreatic pseudocysts remain a widely known complication of acute pancreatitis. While it is rare, fungal infection is a crucial consideration for patients with pancreatic pseudocysts, especially in the context of a lack of an adequate response to antibiotics, deterioration, comorbidities, and immunocompromised states. Conclusion Rapid identification of the microbe responsible for pancreatic pseudocyst infection is vital for time-sensitive treatment and a more rapid recovery, curbing associated morbidity and mortality. Fungal infections of pancreatic pseudocysts remain a rare but well-characterized complication, culminating in significant morbidity and mortality. Telltale signs include unresponsiveness to antibiotics and worsening clinical symptoms. Rapid identification of the responsible microbe is vital for time-sensitive treatment and a more rapid recovery.
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Affiliation(s)
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Muneeb Ullah
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Maha Alkhattab
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | | | | | - Isha Bagwe
- Mercy University Hospital, Cork, Ireland
| | | | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Reema Alsufyani
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dana Almubarak
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Majid Alsufyani
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Helen Huang
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mert Oruk
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Arjun Samy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nagi Alqallaf
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adil Shafi
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Aqsa Adeel
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
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Wong NLJ, Yang M, Fisher D. An argument for serial imaging in a rare case of splenic rupture secondary to complicated pancreatic pseudocyst in a rural patient. Aust J Rural Health 2022; 30:628-630. [PMID: 35639815 DOI: 10.1111/ajr.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Mark Yang
- Department of General Surgery, Dubbo Base Hospital, Dubbo, NSW, Australia
| | - Dean Fisher
- Department of General Surgery, Dubbo Base Hospital, Dubbo, NSW, Australia
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Jaiswal V, Naz S, Ishak A, Batra N, Quinonez J, Mukherjee D, Pokhrel NB. A rare case of pediatric pancreatic pseudocyst. Clin Case Rep 2022; 10:e05879. [PMID: 35600019 PMCID: PMC9107915 DOI: 10.1002/ccr3.5879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/26/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Sidra Naz
- BIDMC Harvard Medical School Boston Massachusetts USA
| | - Angela Ishak
- Larkin Community Hospital South Miami Florida USA
| | - Nitya Batra
- Maulana Azad Medical College New Delhi India
| | - Jon Quinonez
- Larkin Community Hospital South Miami Florida USA
| | | | - Nishan Babu Pokhrel
- Department of Internal Medicine Tribhuvan University Institute of Medicine Maharajgunj Nepal
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Harish C S, Dixit R, Singh S, Prakash A. Cervical extension of pancreatic pseudocyst: An unusual cause of neck stiffness and dysphagia. SA J Radiol 2022; 26:2385. [PMID: 35747785 PMCID: PMC9210193 DOI: 10.4102/sajr.v26i1.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/01/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sneha Harish C
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Sapna Singh
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Ibrahim M, Roshdy N, Taleb A, Alfadda A, Al-Lehibi A, Altonbary A, Galal A, El-Fouly A, Kozlowska A, Khor C, Isayama H, Okasha H, Barthet M, Giovannini M, Pausawasdi N, Eisendrath P, Kongkam P, Ratanachu-ek T, Nakai Y. Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training. Endosc Ultrasound 2022; 11:201-207. [PMID: 35708369 PMCID: PMC9258017 DOI: 10.4103/eus-d-21-00109] [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: 04/22/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022] Open
Abstract
Bckground and Objectives EUS-guided cystogastrostomy is a well-established advanced endoscopic technique with a steep-learning curve which necessitates an ex-vivo simulator that would allow for adequate training. The aim of this study is to evaluate the feasibility of the model in allowing training for EUS-guided cystogastrostomy using lumen-apposing metal stent (LAMS). Subjects and Methods The model was created by ROEYA Training Center, Egypt, using native porcine tissue to create fluid collections simulating both cystic and solid lesions. It was designed and tested in advance while the hydrogel was added on-site. The simulator was evaluated prospectively in five training sessions involving 17 international experts. The task was to successfully deploy the LAMS to drain the created cyst. After using the simulator, the experts were asked to fill a questionnaire to assess their experience. The primary endpoint was overall satisfaction with the model as a training tool. Results All of the experts were satisfied with the model as a tool to train endoscopists for the technique. 76.5% (n = 11) of the experts thought the model to be moderately realistic. Proper visualization was reported by 94.1% of the experts. All experts believed the lesions to be either slightly like or very similar to real lesions. The model was graded "easy" in difficulty by 11 of the experts. Conclusions In all parameters assessed, the experts thought the model to be a useful tool for future training. This preliminary study suggests that the aforementioned simulator can be used to train endoscopists on using LAMS in a risk-free environment.
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Affiliation(s)
- Mostafa Ibrahim
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Noran Roshdy
- ROEYA Gastroenterology, Hepatology and Endoscopy Center, Cairo, Egypt
| | | | - Abdulrahman Alfadda
- Department of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abed Al-Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Altonbary
- Department of Gastroenterology and Hepatology, Mansoura University, Egypt
| | - Ahmed Galal
- Department of Gastroenterology, Alexandria Hospital, Egypt
| | - Amr El-Fouly
- Endemic Medicine Department, Helwan University, Egypt
| | - Anna Kozlowska
- Department of Endoscopy, Hospital of Ministry of Internal Affairs, Szczecin, Poland
| | - Christopher Khor
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Hussein Okasha
- Internal Medicine Department, Kasr Al-Ainy School of Medicine, Cairo University, Egypt
| | - Marc Barthet
- Department of Gastroenterology & Hepatology, Hospital Nord, Marseille, France
| | - Marc Giovannini
- Department of Gastroenterology & Hepatology, Paoli Calmettes Institute, Marseille, France
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Pierre Eisendrath
- Department of Hepato-Gastroenterology, Saint-Pierre Hospital, Brussels, Belgium
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Chulalongkom University, Bangkok, Thailand
| | | | - Yousuke Nakai
- Department of Endoscopy and Endoscopic Surgery, University of Tokyo, Tokyo, Japan
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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).
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Affiliation(s)
- Dimpal Bhakta
- New York University School of Medicine, New York, USA
| | | | - Lauren Khanna
- New York University School of Medicine, New York, 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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35
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Hudgi AR, Coles MJ, Perry I, Vega KJ. Spontaneous duodenal fistulisation from walled-off pancreatic necrosis. BMJ Case Rep 2022; 15:e246422. [PMID: 35228225 PMCID: PMC8886370 DOI: 10.1136/bcr-2021-246422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amit R Hudgi
- Internal Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Michael John Coles
- Internal Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Isaac Perry
- Gastroenterology and Hepatology, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Kenneth J Vega
- Gastroenterology and Hepatology, Augusta University Medical College of Georgia, Augusta, Georgia, USA
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36
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Kim KT, Clark J, Ghneim M, Feliciano DV, Diaz JJ, Harfouche M. Not All Fluid Collections Are Created Equal: Clinical Course and Outcomes of Pancreatic Pseudocysts and Acute Peripancreatic Fluid Collections Requiring Intervention. Am Surg 2022:31348221078955. [DOI: 10.1177/00031348221078955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Knowledge on pancreatic pseudocyst (PP) management has mostly involved large database analysis, which limits understanding of a complex and heterogeneous disease. We aimed to review the clinical course and outcomes of PP and acute peripancreatic fluid collections (APFC) that require intervention at 1 high-volume center. Methods Retrospective review of patients with APFC and PP undergoing drainage (2011-2018) was performed. Patients were divided into groups based on initial intervention: surgical (SR), percutaneous (PC), or endoscopic (EN) drainage. Primary outcome was mortality by initial intervention type. Secondary outcomes included subsequent interventions required, length of stay (LOS), readmission rates, and discharge disposition. Results Of 88 patients, 40 (46.1%) underwent SR, 40 (44.9%) PC, and 8 (9.0%) EN. No patients in EN group had APACHE II scores>20. Pancreatic necrosis was higher in SR (80.5%) and PC (62.5%) groups ( P = .006). There were no differences in mortality, LOS, or readmission rates. Ten patients in the PC group underwent subsequent surgical intervention, of which 9 were due to bowel ischemia. The PC group was 3.4 times more likely to be discharged to rehabilitation over home when compared to the other 2 groups ( P = .04). Conclusion Patients undergoing surgical or percutaneous drainage of APFC and PP have a greater burden of illness and more local complications requiring intervention compared to endoscopic drainage. The heterogeneity in presentation of peripancreatic fluid collections in acute pancreatitis must be considered when evaluating the benefits of each intervention.
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Affiliation(s)
- Kevin T Kim
- University of Maryland School of Medicine, Baltimore, ML, USA
| | - Jaclyn Clark
- University of Maryland School of Medicine, Baltimore, ML, USA
| | - Mira Ghneim
- University of Maryland School of Medicine, Baltimore, ML, USA
| | | | - Jose J Diaz
- University of Maryland School of Medicine, Baltimore, ML, USA
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Hinojosa V, Gamboa E, Varon J. Pancreatic Pseudocysts as a Late Manifestation of COVID-19. Cureus 2022; 14:e22181. [PMID: 35308745 PMCID: PMC8923726 DOI: 10.7759/cureus.22181] [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: 02/13/2022] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease has caused an ongoing pandemic since the end of 2019. It is a transmissible infection caused by the SARS-CoV-2 virus. The highly infectious nature of this illness is based mostly throughout the respiratory tract. However, this virus can affect all systems of the human body, such as the gastrointestinal tract. We report a case of pancreatic pseudocysts as a late manifestation of COVID-19.
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Shah P, Bagga C, Talwar D, Kumar S, Acharya S. Mediastinal Eventration of a Pseudocyst of Pancreas Presenting As Acute Shock Syndrome: Expecting the Unexpected. Cureus 2022; 14:e21433. [PMID: 35198332 PMCID: PMC8856912 DOI: 10.7759/cureus.21433] [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: 01/19/2022] [Indexed: 12/03/2022] Open
Abstract
Pancreatic pseudocyst is a usual complication of chronic pancreatitis. Diagnosis is usually established with the help of cross-sectional imaging. Typical presenting complaints are abdominal pain and vomiting. However, atypical presentations of pseudocyst of the pancreas continue to puzzle clinicians throughout the world, leading to difficulty in diagnosis and hence, the development of life-threatening complications. Here, we report a case of a 47-year-old male who was a known case of chronic pancreatitis related to alcoholism presenting with dyspnea, dysphagia, chest pain, and vomiting with a blood pressure of 70/50 mmHg, which upon evaluation revealed to be a case of peripancreatic pseudocysts extending into mediastinum abutting inferior vena cava and right atrium presenting as acute shock syndrome. The patient was managed with ultrasound-guided pigtail insertion and drainage of pseudocyst of pancreas. Eventually, the patient’s clinical condition did not allow for surgical exploration of the thorax and the patient succumbed.
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Li X, Kelly C, Karb D. Spontaneous Peritoneal Rupture of a Large Pancreatic Pseudocyst in a Critically Ill Patient: Nonoperative Management and a Review of Literature. Pancreas 2022; 51:e7-e8. [PMID: 35195608 DOI: 10.1097/mpa.0000000000001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Guo D, Dai W, Shen J, Zhang M, Shi Y, Jiang K, Guo L. Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis. Digestion 2022; 103:183-191. [PMID: 35026770 DOI: 10.1159/000520892] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. METHODS This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. RESULTS Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. CONCLUSIONS It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.
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Affiliation(s)
- Daxin Guo
- Department of Gastroenterology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Wei Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jingyi Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Luyong Guo
- The Emergency Department, Zhuji People's Hospital, Shaoxing, China
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Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis. Case Rep Radiol 2021; 2021:1919550. [PMID: 34888110 PMCID: PMC8651394 DOI: 10.1155/2021/1919550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.
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Laparoscopic Intervention to Pancreatic Pseudocyst Confers Short-Term Benefits: A Meta-Analysis. Emerg Med Int 2021; 2021:7586338. [PMID: 34840827 PMCID: PMC8612789 DOI: 10.1155/2021/7586338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical techniques, a laparoscopic surgical approach for PPs has been conducted increasingly with comparable outcomes. The present study was conducted to compare the efficacy and safety of surgical intervention for PPs between the laparoscopic approach and the open approach. Methods Databases including Cochrane Library, PubMed, and EMBASE were searched to identify studies that compared the safety and efficacy of surgical intervention for PPs between the laparoscopic approach and the open approach (until Aug 1st 2020). Results A total of 6 studies were eligible in qualitative synthesis. The laparoscopic approach was associated with less intraoperative blood loss (MD = -69.97; 95% CI: -95.14 to -44.70, P < 0.00001; P=0.86 for heterogeneity) and shorter operating time (MD = -33.12; 95% CI: -62.24 to -4.00, P=0.03; P < 0.00001 for heterogeneity). There was no significant difference found between the two approaches regarding the success rate and the recurrence rate. The postoperative complications and mortality rates were comparable between the two approaches. Conclusions The laparoscopic approach for the surgical intervention of PPs is safe and efficacious with shorter-term benefits.
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Murthi M, Abusalim A, Haque Z, Acob C. A Case of Pancreatic Duct Leak Presenting as Lower Extremity Pain and Edema. Cureus 2021; 13:e18839. [PMID: 34804694 PMCID: PMC8592793 DOI: 10.7759/cureus.18839] [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: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
Pancreatic pseudocyst from pancreatic duct leak is one of the common complications of both acute and chronic pancreatitis. The presentation of such leaks can range from patients being completely asymptomatic to septic shock. Extra-abdominal collections of fluid due to pancreatic duct leaks are very rare. We describe a diagnostically challenging patient with acute chronic pancreatitis presenting with lower extremity swelling and pain, who was found to have a pancreatic fluid leak into the right iliopsoas, right gluteal, and thigh muscle compartment. Despite endoscopic stenting of the pancreatic duct and multiple percutaneous drain placement and antibiotic treatment for abscess formation, the patient's condition deteriorated clinically. Surgical options could not be pursued due to poor functional status.
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Affiliation(s)
- Mukunthan Murthi
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | | | - Zohaib Haque
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Christine Acob
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Michael O, Derick K, Srikant S, Xavier BF, Darshit D. Cystocolostomy as an unusual approach to recurrent pancreatic pseudocyst in a Ugandan male with dense hepatogastroduodenal adhesions: A case report. Int J Surg Case Rep 2021; 88:106546. [PMID: 34741860 PMCID: PMC8577166 DOI: 10.1016/j.ijscr.2021.106546] [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: 10/10/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Pancreatic pseudocyst is one of the most frequent late complications of acute pancreatitis with increasing prevalence in chronic pancreatitis. Other causes include abdominal trauma, biliary tract disease, and other idiopathic causes. 85% resolve spontaneously within 4–6 weeks. Interventions are required for persistently symptomatic, large and complicated pancreatic pseudocysts. Cystocolostomy is a rarely reported pancreatic pseudocyst drainage option. Case presentation 20-year-old male with large recurrent pancreatic pseudocyst following trauma underwent 2 exploratory laparotomies from a peripheral hospital, before referral to Lubaga hospital. Ultrasound-guided cyst drainage was performed. He was readmitted two weeks later with features of cyst recurrence. Re-laparotomy was done and the stomach, duodenum and proximal jejunum were inaccessible due to extensive dense non-obstructive adhesions. Therefore, we performed a transverse cystocolostomy. Patient improved and was discharged on 5th post-operative day. Review was unremarkable at 6 weeks and 3 months post-surgery. Clinical discussion Current management of pancreatic pseudocyst is percutaneous, endoscopic or laparoscopic drainage. However in cases of large recurrent cysts despite the above interventions, open surgery still has a role. Cystogastrostomy, cystoduodenostomy or cystojejunostomy are the commonly performed drainage options. These 3 options were not possible in this patient due to dense adhesions, hence we performed a transverse cystocolostomy with no post-operative complications. Possible complications from the procedure might include recurrent pancreatitis, pancreatic abscess and stool leak into the pancreatic duct. Conclusion In cases of inaccessibility to the stomach, duodenum and jejunum due to non-obstructing dense adhesions, a pancreatic cystocolostomy can be performed with equally good outcomes. A rarely reported alternative surgical option for large recurrent pancreatic pseudocysts. Pancreatic cystocolostomy has equally good outcomes. Challenges of dense adhesions in patients with repeat surgeries in the setting of pancreatitis.
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Affiliation(s)
- Okello Michael
- Department of Surgery, Uganda Martyrs Hospital Lubaga, Kampala City, Uganda; Department of Anatomy, Makerere University College of Health Sciences, Kampala City, Uganda.
| | - Kayondo Derick
- Department of Surgery, Uganda Martyrs Hospital Lubaga, Kampala City, Uganda
| | - Sanjanaa Srikant
- Department of Surgery, Makerere University College of Health Sciences, Kampala City, Uganda
| | - Baseka Francis Xavier
- Department of Surgery, Uganda Martyrs Hospital Lubaga, Kampala City, Uganda; Department of Surgery, Makerere University College of Health Sciences, Kampala City, Uganda
| | - Dave Darshit
- Department of Surgery, Uganda Martyrs Hospital Lubaga, Kampala City, Uganda
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Zhu G, Peng YS, Fang C, Yang XL, Li B. Percutaneous drainage in the treatment of intrahepatic pancreatic pseudocyst with Budd-Chiari syndrome: A case report. World J Clin Cases 2021; 9:8476-8481. [PMID: 34754856 PMCID: PMC8554436 DOI: 10.12998/wjcc.v9.i28.8476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/17/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intrahepatic pancreatic pseudocyst (IHPP) is an extremely rare complication of acute pancreatitis, with only a few cases previously described in the literature. To the best of our knowledge, IHPP with Budd-Chiari syndrome (BCS) has not yet been described.
CASE SUMMARY A 35-year-old male presented with abdominal pain, vomiting and anorexia, followed by severe swelling of the lower body after 4 d. The morphological assessment (using computed tomography revealed the presence of a huge cyst of 18.28 cm × 10.34 cm under the liver capsule accompanied by a large amount of ascites. Percutaneous puncture allowed us to detect a high level of amylase in the collection, confirming the diagnosis of IHPP. The cyst was treated by percutaneous drainage, producing complete resolution of the cyst.
CONCLUSION IHPP can be treated with percutaneous drainage, endoscopic drainage, surgery or even conservative treatment, depending on the specific condition. We recommend percutaneous drainage as the first choice of treatment when IHPP with secondary BCS.
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Affiliation(s)
- Gang Zhu
- Department of General Surgery (Hepatobiliary Surgery), Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Yi-Sheng Peng
- Department of General Surgery (Hepatobiliary Surgery), Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Cheng Fang
- Department of General Surgery (Hepatobiliary Surgery), Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Xiao-Li Yang
- Department of General Surgery (Hepatobiliary Surgery), Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Bo Li
- Department of General Surgery (Hepatobiliary Surgery), Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Supapannachart KJ, Funk CR, Gensler LM, Butters MP. Splenic injury following endoscopic drainage of a large pancreatic pseudocyst: a case report. J Med Case Rep 2021; 15:409. [PMID: 34391461 PMCID: PMC8364695 DOI: 10.1186/s13256-021-03004-z] [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: 03/02/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. CASE PRESENTATION A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient's symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. CONCLUSIONS While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.
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Affiliation(s)
| | - Christopher R Funk
- Emory University School of Medicine, 100 Woodruff Circle, 30322, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, 30322, Atlanta, Georgia
| | - Lauren M Gensler
- Emory University School of Medicine, 100 Woodruff Circle, 30322, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, 30322, Atlanta, Georgia
| | - Matthew P Butters
- Emory University School of Medicine, 100 Woodruff Circle, 30322, Atlanta, Georgia. .,Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, 30322, Atlanta, Georgia.
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Madhyastha SP, Banda GR, Acharya RV, Balaraju G. Spontaneous rupture of pancreatic pseudocyst into the stomach. BMJ Case Rep 2021; 14:14/7/e244839. [PMID: 34301710 DOI: 10.1136/bcr-2021-244839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sharath P Madhyastha
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Giridhar Reddy Banda
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raviraja V Acharya
- Internal Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girisha Balaraju
- Gastroenterlogy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Hao W, Chen Y, Jiang Y, Yang A. Endoscopic Versus Laparoscopic Treatment for Pancreatic Pseudocysts: A Systematic Review and Meta-analysis. Pancreas 2021; 50:788-795. [PMID: 34347721 PMCID: PMC8376268 DOI: 10.1097/mpa.0000000000001863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/21/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the efficacy and safety of endoscopic treatment for pancreatic pseudocysts (PPCs) compared with laparoscopic treatment. METHODS The Embase, Medline, Cochrane Library, Web of Science databases, China National Knowledge Infrastructure Chinese citation database, and WANFANG database were systematically searched to identify all comparative trials investigating endoscopic versus laparoscopic treatment for PPC. The main outcome measures included treatment success rate, adverse events, recurrence rate, operation time, intraoperative blood loss, and hospital stay. RESULTS Six studies with 301 participants were included. The results suggested that there was no difference in rates of treatment success (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.40-2.01; P = 0.79), adverse events (OR, 0.80, 95% CI, 0.38-1.70; P = 0.57), or recurrence (OR, 0.55, 95% CI, 0.22-1.40; P = 0.21) between endoscopic and laparoscopic treatments. However, the endoscopic group exhibited reduced operation time (weighted mean difference [WMD], -67.11; 95% CI, -77.27 to -56.96; P < 0.001), intraoperative blood loss (WMD, -65.23; 95% CI, -103.38 to -27.08; P < 0.001), and hospital stay (WMD, -2.45; 95% CI, -4.74 to -0.16; P = 0.04). CONCLUSIONS Endoscopic treatment might be suitable for PPC patients.
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Affiliation(s)
| | - Yunli Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Aiming Yang
- From the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Hasan T, Jha P, Thippeswamy S. Recurrent Pancreatic Pseudocysts Due to Alcohol-Related Chronic Pancreatitis With Double-Duct Sign and Spontaneous Rupture. Cureus 2021; 13:e16039. [PMID: 34345538 PMCID: PMC8321735 DOI: 10.7759/cureus.16039] [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: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
A 36-year-old female presented with recurrent attacks of alcohol-related acute on chronic pancreatitis complicated by a pancreatic pseudocyst in the head of the pancreas. The cyst was causing obstruction of the common bile duct (CBD) and pancreatic duct (PD) on magnetic resonance cholangiopancreatography (MRCP). She underwent endoscopic ultrasound (EUS)-guided aspiration of the cyst to dryness. A few months later, she presented with epigastric pain and jaundice. MRI pancreas and MRCP revealed a pancreatic cyst in the head of the pancreas, which had grown in size, compressing the CBD and PD with extra and intrahepatic biliary dilatation. There was a recurrence of a new lobulated peripancreatic pseudocyst, which had ruptured resulting in a large collection compressing the right renal capsule. Percutaneous drainage of the ruptured pseudocyst was performed, followed by endoscopic retrograde cholangiopancreatography (ERCP) that revealed distal CBD stricture, which was stented. Her symptoms improved and she was discharged with no further recurrences of obstructive jaundice during the one-year follow-up period.
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Affiliation(s)
- Tanveer Hasan
- Internal Medicine, East Kent Hospitals University NHS Foundation Trust, Ashford, GBR
| | - Pranav Jha
- Internal Medicine, East Kent Hospitals University NHS Foundation Trust, Ashford, GBR
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Ye J, Wang L, Lu S, Yang D, Hu W, Lu H, Zhang Y. Clinical study on cystogastrostomy and Roux-en-Y-type cystojejunostomy in the treatment of pancreatic pseudocyst: A single-center experience. Medicine (Baltimore) 2021; 100:e25029. [PMID: 33725885 PMCID: PMC7969232 DOI: 10.1097/md.0000000000025029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/26/2020] [Accepted: 02/07/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis' occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.
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Affiliation(s)
- Jun Ye
- Department of Hepatopancreatobiliary Surgery
| | - Lan Wang
- Department of General Practice, Chengdu Second People's Hospital
| | - Shan Lu
- Department of Breast Surgery
| | | | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huimin Lu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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