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Ugeskrift For Laeger Nov 2014Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential,... (Review)
Review
Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.
Topics: Algorithms; Carcinoma, Pancreatic Ductal; Cystadenocarcinoma, Mucinous; Cystadenoma, Serous; Humans; Pancreatic Cyst; Pancreatic Pseudocyst
PubMed: 25394925
DOI: No ID Found -
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 -
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 -
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 -
Pathogens (Basel, Switzerland) May 2023The giant liver fluke () is an invasive parasite found permanently in three foci in Europe. The fluke has an indirect life cycle involving a final and an intermediate...
The giant liver fluke () is an invasive parasite found permanently in three foci in Europe. The fluke has an indirect life cycle involving a final and an intermediate host. The currently accepted terminology determines three types of final hosts: definitive, dead-end, and aberrant hosts. Recently, roe deer () has been classified as an aberrant host, which cannot contribute to the reproduction of . This study investigated the hatchability of eggs of red deer () and roe deer origin to compare the suitability of the two host species for the maintenance of the parasite. The study was carried out on a newly invaded area, two years after the first reported observation of . The prevalence of the parasite proved to be 68.4% (CI95% 44.6-85.3%) in red deer and 36.7% (CI95% 24.8-50.0%) in roe deer. The difference between the two species was confirmed to be significant ( = 0.02). The mean intensity proved to be 10.0 (CI95% 4.9-22.6) and 7.59 (CI95% 2.7-24.2) in the red deer and the roe deer, respectively. The difference of the mean intensities did not prove to be significant ( = 0.72). Of the 70 observed pseudocysts, 67 originated from red deer and 3 from roe deer. Most of the pseudocysts contained two flukes, while a few pseudocysts contained one or three parasites. Egg production was observed in all three types of pseudocysts. We did not find more than three flukes in any pseudocyst. The apparent proportion of self-fertilisation in flukes without mating partners was 23.5% and 100% in red deer and roe deer, respectively. The survival of single-parent eggs was not confirmed to be worse than that of gregarious parents. The viability of offspring originating from roe and red deer differed significantly. Our findings suggest that adapted to the new populations of susceptible hosts rather than vice versa.
PubMed: 37242411
DOI: 10.3390/pathogens12050741 -
The Pan African Medical Journal 2016
Topics: Female; Humans; Low Back Pain; Middle Aged; Nephrectomy; Pyelonephritis, Xanthogranulomatous
PubMed: 27642430
DOI: 10.11604/pamj.2016.24.91.9598 -
Orthopaedic Surgery May 2023Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management... (Review)
Review
OBJECTIVE
Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management of PDPs.
METHODS
Nine patients with PDP who received surgical treatment at our institution from January 2014 to December 2021 were retrospectively reviewed. A systematic review of the literature on PDP was performed. The demographic data, clinical and imaging features, surgical options and patient prognosis were analyzed.
RESULTS
Among the nine patients treated at our center, seven were male and two were female. The mean patient age (± standard deviation) at the time of surgery was 28.3 ± 5.7 years (range 18-37 years). The first operation performed on seven patients was percutaneous endoscopic transforaminal discectomy (PETD) and two patients underwent microdiscectomy. The time to conservative treatment before surgical intervention was 20 ± 9.2 days. In three cases, the disc cysts were located in L4/5 and in six cases the lesions were located in L5/S1. Intervertebral disc cyst interventions included foraminal scope (three cases), open discectomy (three cases), conservative treatment with a quadrant channel (one case) and CT-guided puncture (one case). All patients fully recovered after surgery and the mean follow-up time was 3.5 ± 2.1 years. A literature review identified 14 relevant articles that reported 43 PDP cases of PDP.
CONCLUSION
PDP occurs in Asian males with mild intervertebral disc degeneration and occurs 1 month after discectomy. Treatment should be based on specific patient scenarios. Conservative treatment is necessary and surgery should be performed with caution.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Intervertebral Disc Displacement; Retrospective Studies; Spinal Puncture; Lumbar Vertebrae; Diskectomy, Percutaneous; Endoscopy; Cysts; Treatment Outcome
PubMed: 36999347
DOI: 10.1111/os.13689 -
IDCases 2019Pancreatic pseudocysts are abnormal mature collections of pancreatic fluid that can develop in association with acute or chronic pancreatitis. Here, we share the...
INTRODUCTION
Pancreatic pseudocysts are abnormal mature collections of pancreatic fluid that can develop in association with acute or chronic pancreatitis. Here, we share the discovery of an infected hepatic subcapsular pseudocyst of the pancreas causing septic shock following endoscopic retrograde cholangiopancreatography (ERCP).
PRESENTATION OF CASE
A 55-year-old woman with ethanol-related chronic pancreatitis and biliary stricture was transferred to the ICU for hypotension 8 hours following ERCP. Examination revealed mild right upper quadrant tenderness without sign of peritonitis. Laboratory studies were notable for leukocytosis (14.6 k/L) and slightly elevated serum lipase (489 U/L). Abdominal CT scan revealed a previously undescribed subcapsular fluid collection. She underwent CT-guided percutaneous subcapsular drainage with return of opaque yellowish fluid. Fluid analysis showed elevated lipase of 62,901 U/L with cultures positive for ESBL , , and .
DISCUSSION
A majority of pancreatic pseudocysts develop in peripancreatic regions, while, in a recent study, over a quarter of cases were found in usual sites. The management of subcapsular pseudocysts has not been standardized and often involves endoscopic or percutaneous drainage. Operative intervention is reserved for severe infection or rupture in patients with intrahepatic pseudocysts. Rarely do subcapsular pseudocysts become infected. In this case, we postulate the pseudocyst became seeded by bacteria during ERCP resulting in infection and then sepsis.
CONCLUSION
This case report highlights an atypical presentation of pancreatic pseudocyst as well as a rare septic complication of ERCP.
PubMed: 30847279
DOI: 10.1016/j.idcr.2019.e00507