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Surgical Pathology Clinics Dec 2016Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is... (Review)
Review
Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed.
Topics: Alcohol-Induced Disorders; Autoimmune Diseases; Carcinoma, Pancreatic Ductal; Chronic Disease; Diagnosis, Differential; Humans; Pancreas; Pancreatic Ducts; Pancreatic Pseudocyst; Pancreatitis
PubMed: 27926364
DOI: 10.1016/j.path.2016.05.008 -
Experimental and Therapeutic Medicine Feb 2021Advances in radiological techniques have led to an increase in the number of diagnoses of pancreatic pseudocyst, which is the most common pancreatic cyst lesion disease,... (Review)
Review
Advances in radiological techniques have led to an increase in the number of diagnoses of pancreatic pseudocyst, which is the most common pancreatic cyst lesion disease, accounting for two-thirds of all pancreatic cyst lesions. Historically, the management of pancreatic pseudocyst has been achieved through the use of conservative treatments and surgery; however, due to the complications and recurrence rate associated with these techniques, the management of pancreatic pseudocyst is challenging. Surgeons and gastroenterologists have attempted to determine the optimal management technique to treat pancreatic pseudocyst to reduce complications and the recurrence rate. From these investigations, percutaneous catheter, surgical and endoscopic drainage with ultrasonography guidance have become promising management techniques. The present review aimed to summarize the diagnostic and therapeutic methods used for the management of pancreatic pseudocyst and to compare percutaneous catheter, surgical and endoscopic drainage.
PubMed: 33456526
DOI: 10.3892/etm.2020.9590 -
Revista Espanola de Enfermedades... Jun 2020Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis,... (Review)
Review
Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage.
Topics: Acute Disease; Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis, Acute Necrotizing
PubMed: 32450706
DOI: 10.17235/reed.2020.6814/2019 -
Clinical Endoscopy Jan 2017Mediastinal pseudocysts are a rare complication of acute pancreatitis. Lack of uniform treatment standards makes the management of this condition a clinical challenge....
Mediastinal pseudocysts are a rare complication of acute pancreatitis. Lack of uniform treatment standards makes the management of this condition a clinical challenge. We report the case of a 43-year-old patient who presented with a left pleural effusion. Pleural fluid revealed a high amylase concentration consistent with a pancreaticopleural fistula. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a disruption of the pancreatic duct with free outflow of contrast medium into the thoracic cavity. A pancreatic stent was placed. The second day after the ERCP, the patient developed septic shock and was admitted to the intensive care unit. Computed tomography (CT) revealed mediastinal pseudocysts and bilateral pleural effusions. After bilateral drainage of the pleural cavities, the patient improved clinically, and a follow-up CT scan showed that the fluid collection and pseudocysts had resolved. We discuss the optimal strategies for diagnosing and treating patients with pancreatic thoracic pseudocysts and fistulas, as well as review the management of these conditions.
PubMed: 27641151
DOI: 10.5946/ce.2016.089 -
Cureus Jul 2022Pancreatic pseudocysts are a common complication of pancreatitis. Conservative management and repeat imaging are appropriate to monitor spontaneous regression. However,...
Pancreatic pseudocysts are a common complication of pancreatitis. Conservative management and repeat imaging are appropriate to monitor spontaneous regression. However, in some cases, rupture and haemorrhage of pseudocysts can lead to life-threatening events requiring urgent intervention. We present a male patient in his 30s who was presented to the emergency department with severe pancreatitis in the context of alcohol excess. Past medical history included pancreatitis with a small pseudocyst and splenic vein thrombosis for which he was anticoagulated six weeks previously. Computer tomography of the abdomen and pelvis showed an interval increase in his pseudocyst with haemorrhage secondary to a suspected splenic artery pseudoaneurysm. He was admitted for attempted embolisation and observation. Serial imaging demonstrated progression of the pancreatic pseudocyst and then spontaneous interval decompression via a transgastric fistula, leading to a natural cystogastrostomy confirmed on subsequent endoscopy. We discuss the uncommon sequelae of a complication of pancreatitis, and consider the hypotheses related to this rare occurrence, with suggestions for management and follow-up of these patients.
PubMed: 36035043
DOI: 10.7759/cureus.27250 -
Chirurgia (Bucharest, Romania : 1990) 2018Frequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are... (Review)
Review
Frequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are available, from minimum invasive methods to complex open surgical techniques. The indications of drainage include symptomatic pseudocysts, large pseudocysts along with the development of complications such as hemorrhage, secondary infection, and rupture. Choosing the best drainage technique is often a challenge. Multiple factors need to be considered in managing a pseudoocyst, including its location, dimension and the patient's general state and comorbidities. Thus, a therapeutical algorithm may be of great use in choosing the most feasible technique for the diagnosed lesion that is also patient-adapted.
Topics: Diagnosis, Differential; Drainage; Humans; Pancreatectomy; Pancreatic Pseudocyst; Pancreatitis; Risk Factors; Treatment Outcome
PubMed: 29981666
DOI: 10.21614/chirurgia.113.3.353