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World Journal of Gastroenterology Nov 2014Chronic pancreatitis is an ongoing disease characterized by persistent inflammation of pancreatic tissues. With disease progression, patients with chronic pancreatitis... (Review)
Review
Chronic pancreatitis is an ongoing disease characterized by persistent inflammation of pancreatic tissues. With disease progression, patients with chronic pancreatitis may develop troublesome complications in addition to exocrine and endocrine pancreatic functional loss. Among them, a pseudoaneurysm, mainly induced by digestive enzyme erosion of vessels in proximity to the pancreas, is a rare and life-threatening complication if bleeding of the pseudoaneurysm occurs. At present, no prospective randomized trials have investigated the therapeutic strategy for this rare but critical situation. The role of arterial embolization, the timing of surgical intervention and even surgical procedures are still controversial. In this review, we suggest that dynamic abdominal computed tomography and angiography should be performed first to localize the bleeders and to evaluate the associated complications such as pseudocyst formation, followed by arterial embolization to stop the bleeding and to achieve early stabilization of the patient's condition. With advances and improvements in endoscopic devices and techniques, therapeutic endoscopy for pancreatic pseudocysts is technically feasible, safe and effective. Surgical intervention is recommended for a bleeding pseudoaneurysm in patients with chronic pancreatitis who are in an unstable condition, for those in whom arterial embolization of the bleeding pseudoaneurysm fails, and when endoscopic management of the pseudocyst is unsuccessful. If a bleeding pseudoaneurysm is located over the tail of the pancreas, resection is a preferential procedure, whereas if the lesion is situated over the head or body of the pancreas, relatively conservative surgical procedures are recommended.
Topics: Aneurysm, False; Aneurysm, Ruptured; Embolization, Therapeutic; Hemostasis, Endoscopic; Humans; Pancreatectomy; Pancreatitis, Chronic; Predictive Value of Tests; Radiography, Abdominal; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25473165
DOI: 10.3748/wjg.v20.i43.16132 -
Gastroenterology Nursing : the Official... 2019Acute pancreatitis is an inflammatory process of the pancreas, which can range from a localized inflammatory process to a systemic response, resulting in sepsis and... (Comparative Study)
Comparative Study Review
Acute pancreatitis is an inflammatory process of the pancreas, which can range from a localized inflammatory process to a systemic response, resulting in sepsis and multisystem failure. Pancreatic fluid collections are a complication of pancreatitis. Treatment of these fluid collections is dependent on correct classification. The 2012 Atlanta Criteria divides fluid collections into four categories: acute peripancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Endoscopic ultrasound-guided management of chronic fluid collections is currently the preferred treatment modality. Endoscopy nurses need to be aware of their role in this treatment approach. Continued research in this area will lead to both advancements in equipment and treatment options.
Topics: Drainage; Endoscopy; Endosonography; Female; Humans; Male; Pancreatic Pseudocyst; Pancreatitis; Prognosis; Risk Assessment; Severity of Illness Index; Surgery, Computer-Assisted; Survival Rate; Treatment Outcome
PubMed: 31574068
DOI: 10.1097/SGA.0000000000000396 -
Turkish Archives of Pediatrics Jan 2023The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This...
OBJECTIVE
The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This study aimed to reveal the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children at a tertiary care hospital.
MATERIALS AND METHODS
The patients with acute pancreatitis and acute recurrent pancreatitis diagnosed between January 2007 and December 2018 were included. Demographic and clinical features, follow-up period, and interventions were noted. Imaging features were evaluated for pancreatic enlargement, peripancreatic fluid, and biliary ducts for initial examination and pancreas parenchymal necrosis, peripancreatic collection, walled-off necrosis, pseudocyst, parenchymal atrophy, and biliary ductal dilatation for follow-up.
RESULTS
The study included 74 patients with a mean age of 9 ± 4.9 years. The most common causes of acute pancreatitis and acute recurrent pancreatitis were biliary tract anomalies (n = 21), biliary ductal stones (n = 9), and cystic fibrosis (n = 8). Findings consistent with acute pancreatitis were determined by ultrasound in 40.5% (n = 30/74), whereas by magnetic resonance imaging in 60% (n = 39/65). Forty-one percent of the patients (n = 16) with positive magnetic resonance imaging findings did not show any findings on ultrasound. Acute recurrent pancreatitis was seen in 32 patients (43.2%). Follow-up imaging was performed in 55 patients (74.3%) between 2 months and 11 years. At follow-up, 8 patients had peripancreatic collections (6 walled-off necrosis and 2 pseudocysts).
CONCLUSION
Recognizing the imaging findings of acute pancreatitis and its complications is crucial. Magnetic resonance imaging should be preferred as a second option following ultrasound, with the advantages of biliary ductal system delineation and better characterization of complications.
PubMed: 36598217
DOI: 10.5152/TurkArchPediatr.2022.22130 -
British Journal of Hospital Medicine... Dec 2014Acute pancreatitis is seen commonly on the surgical take. It can be complicated by the development of pseudocysts and necrosis. This review discusses each of these in... (Review)
Review
Acute pancreatitis is seen commonly on the surgical take. It can be complicated by the development of pseudocysts and necrosis. This review discusses each of these in turn and outlines the different management strategies now on offer.
Topics: Acute Disease; Humans; Necrosis; Pancreatic Pseudocyst; Pancreatitis
PubMed: 25488533
DOI: 10.12968/hmed.2014.75.12.698 -
Expert Review of Gastroenterology &... Feb 2015Over the last several years, there have been refinements in the understanding and nomenclature regarding the natural history of acute pancreatitis. Patients with acute... (Review)
Review
Over the last several years, there have been refinements in the understanding and nomenclature regarding the natural history of acute pancreatitis. Patients with acute pancreatitis frequently develop acute pancreatic collections that, over time, may evolve into pancreatic pseudocysts or walled-off necrosis. Endoscopic management of these local complications of acute pancreatitis continues to evolve. Treatment strategies range from simple drainage of liquefied contents to repeated direct endoscopic necrosectomy of a complex necrotic collection. In patients with chronic pancreatitis, pancreatic pseudocysts may arise as a consequence of pancreatic ductal obstruction that then leads to pancreatic ductal disruption. In this review, we focus on the indications, techniques and outcomes for endoscopic therapy of pancreatic pseudocysts and walled-off necrosis.
Topics: Disease Management; Drainage; Endoscopy; Humans; Necrosis; Pancreas; Pancreatic Pseudocyst; Stents; Treatment Outcome
PubMed: 25222140
DOI: 10.1586/17474124.2014.943186 -
World Journal of Gastroenterology Dec 2015Pancreatic fluid collections (PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis... (Review)
Review
Pancreatic fluid collections (PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walled-off necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging (MRI) performs better than computed tomography (CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis (seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis (solid debris delineation) and management (drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with (18)F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.
Topics: Acute Disease; Cholangiopancreatography, Magnetic Resonance; Diagnostic Imaging; Drainage; Endosonography; Humans; Multimodal Imaging; Necrosis; Pancreas; Pancreatic Cyst; Pancreatic Pseudocyst; Pancreatitis; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Severity of Illness Index; Stents; Tomography, X-Ray Computed
PubMed: 26730150
DOI: 10.3748/wjg.v21.i48.13403 -
Child's Nervous System : ChNS :... Dec 2017The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt...
PURPOSE
The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure.
METHODS
We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children's Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified.
RESULTS
Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6).
CONCLUSION
The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.
Topics: Abdomen; Adolescent; Child; Child, Preschool; Cysts; Equipment Failure; Female; Humans; Hydrocephalus; Male; Postoperative Complications; Reoperation; Retrospective Studies; Treatment Outcome; Ventriculoperitoneal Shunt
PubMed: 28993858
DOI: 10.1007/s00381-017-3609-5 -
Insights Into Imaging Jan 2019In recent years, technological advancements including endoscopic ultrasound (EUS) guidance and availability of specifically designed stents further expanded the... (Review)
Review
In recent years, technological advancements including endoscopic ultrasound (EUS) guidance and availability of specifically designed stents further expanded the indications and possibilities of interventional endoscopy. Although technically demanding and associated with non-negligible morbidity, advanced pancreatic endoscopic techniques now provide an effective minimally invasive treatment for complications of acute and chronic pancreatitis.Aiming to provide radiologists with an adequate familiarity, this pictorial essay reviews the indications, techniques, results and pre- and post-procedural cross-sectional imaging appearances of advanced endoscopic interventions on the pancreas and pancreatic ductal system. Most of the emphasis is placed on multidetector CT and MRI findings before and after internal drainage of pseudocysts and walled-off necrosis via EUS-guided endoscopic cystostomy, and on stent placement to relieve strictures or disruption of the main pancreatic duct, respectively in patients with chronic pancreatitis and disconnected pancreatic duct syndrome.
PubMed: 30689070
DOI: 10.1186/s13244-019-0689-7 -
DEN Open Apr 2024Perforation is a rare but fatal complication of pancreatic pseudocysts. It is generally diagnosed by computed tomography imaging with hemorrhagic ascites and...
Perforation is a rare but fatal complication of pancreatic pseudocysts. It is generally diagnosed by computed tomography imaging with hemorrhagic ascites and pneumoperitoneum. Traditionally, surgery was the mainstream for treating this critical state. Recently, alternative therapies have also been deemed useful. Herein, we describe the case of a 54-year-old with perforation of pancreatic pseudocyst which was confirmed by endoscopy, and managed by endoscopic and percutaneous drainage. The patient was initially referred to our hospital for treatment of a pancreatic pseudocyst with hemorrhagic ascites and underwent endoscopic ultrasonographic-guided stent placement. The next day, imaging demonstrated pneumoperitoneum and worsening ascites consistent with perforation, and the patient was treated conservatively. One week later, the patient developed severe abdominal pain. Endoscopy showed a large perforation site inside the pseudocyst connected to a large fluid collection and direct visualization inside the pseudocyst and fluid collection. The fluid collection was treated with percutaneous drainage, and the patient was discharged one week later with no complications.
PubMed: 37711642
DOI: 10.1002/deo2.295 -
International Journal of Surgery Case... Jan 2022Cyst is commonly found in oral and maxillofacial region, but non-pancreatic pseudo cyst in this region is quite rare. None of the such cases have been reported so far....
INTRODUCTION AND IMPORTANCE
Cyst is commonly found in oral and maxillofacial region, but non-pancreatic pseudo cyst in this region is quite rare. None of the such cases have been reported so far. Presented here is the case of non-pancreatic pseudo cyst in the right cheek. A description and management of this pathology through open surgery is given, while preserving the anatomy of the cheek.
CASE PRESENTATION
The authors report a non-pancreatic pseudo cyst of the right cheek in a 4 years old boy. His parents noticed swelling over right cheek which slowly increases in size without any other associated symptoms. The swelling was firm, non-tender, nonfluctuant, non-pulsatile, margin was distinct, overlying mucosa was normal in colour, aspiration was negative, 3x2x1 cc in size. The surgical excision of the tumour was performed through an intraoral approach under general anaesthesia. Intraoperatively we found clotted blood confined within fibrous capsule. During one year postoperative follow-up there was no sign of recurrence.
CLINICAL DISCUSSION
Pancreatic pseudocysts are benign soft tissue lesion occurring most commonly in pancreas. They are rarely encountered in the soft tissue of Oral and Maxillofacial region. It is the first case of non-pancreatic pseudocyst found in soft tissue of oral and maxillofacial region. The etiopathogenesis of these pseudocysts is not known yet. It may be considered as soft tissue counterpart of Aneurysmal Bone Cyst (ABC).
CONCLUSION
Non pancreatic pseudo cysts may form in soft tissue of oral and maxillofacial region.
PubMed: 34902702
DOI: 10.1016/j.ijscr.2021.106639