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JACC. Case Reports Apr 2024A 54-year-old male with chronic pancreatitis presented with dyspnea. Computed tomography scans demonstrated a subdiaphragmatic fluid collection with pericardial...
A 54-year-old male with chronic pancreatitis presented with dyspnea. Computed tomography scans demonstrated a subdiaphragmatic fluid collection with pericardial fistulization. Pericardial fluid cultures were polymicrobial in nature. Purulent pericarditis is rare but carries a high mortality rate. We present the first documented case of pancreatico-pericardial fistulization causing purulent pericarditis.
PubMed: 38465285
DOI: 10.1016/j.jaccas.2024.102288 -
Ear, Nose, & Throat Journal Mar 2024
PubMed: 38465483
DOI: 10.1177/01455613241238619 -
International Journal of Surgery Case... Sep 2023Maxillary sinus floor augmentation is acceptable and safe for bone augmentation prior to insertion of dental implants in atrophied maxillary bones. Anatomical variations...
Radiographic feature changes in an antral pseudocyst that existed prior to sinus floor augmentation and dental implant placement, 15 years after initial detection - a case report.
INTRODUCTION AND IMPORTANCE
Maxillary sinus floor augmentation is acceptable and safe for bone augmentation prior to insertion of dental implants in atrophied maxillary bones. Anatomical variations and lesions of the maxillary sinus, including antral pseudocysts, are common radiological findings that can affect the outcomes of maxillary sinus augmentation. We show the changes in the radiological features of an antral pseudocyst that existed before maxillary sinus augmentation and 15 years after the insertion of dental implants.
CASE PRESENTATION
The patient was a 69-year-old male with an unremarkable medical history. The initial orthopantomogram revealed a very large antral pseudocyst in the left maxillary sinus. After upper left second molar extraction and maxillary sinus augmentation, two dental implants were inserted in regions 26 and 27. The pseudocyst had changed radiologically 15 years later, but a biopsy showed no characteristic changes, and the dental implants showed no functional failures.
CLINICAL DISCUSSION
We present a case of an antral pseudocyst that was not removed before or during sinus floor augmentation. A debate is ongoing regarding whether antral pseudocysts affect maxillary sinus augmentation, and various strategies have been applied to prevent intraoperative and postoperative complications, including removal of pseudocysts 3-12 months before maxillary sinus augmentation, removal during maxillary sinus augmentation, and leaving them alone when the floor is raised.
CONCLUSION
The present case showed a preexisting antral pseudocyst at maxillary sinus floor augmentation and insertion of the implants, which changed radiologically 15 years later, but did not affect the function of the dental implants.
PubMed: 37603911
DOI: 10.1016/j.ijscr.2023.108653 -
Scientific Reports Mar 2024Pancreatic fluid collections (PFCs) including pancreatic pseudocyst (PP) and walled-off necrosis (WON) are complications after acute pancreatitis. We aimed to evaluate...
Pancreatic fluid collections (PFCs) including pancreatic pseudocyst (PP) and walled-off necrosis (WON) are complications after acute pancreatitis. We aimed to evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) placement to manage PFCs. Between June 2019 and May 2023, patients with symptomatic PFCs who underwent EUS-guided electrocautery-enhanced LAMS drainage were enrolled retrospectively from eight tertiary centers in Taiwan. In total, 33 [14 (42.42%) PP and 19 (57.58%) WON] patients were enrolled. Gallstones (27.27%) and abdominal pain (72.73%) were the most common etiology and indication for drainage. The technical and clinical success rates were 100% and 96.97%, respectively, and the mean procedure time was 30.55 (± 16.17) min. Complications included one (3.03%) case of self-limited bleeding; there were no cases of mortality. Seven (21.21%) patients had recurrence. Patients with disconnected pancreatic duct syndrome (DPDS) had a higher recurrence rate than those without (71.43% vs. 38.46%, p = 0.05). After replacing LAMSs with transmural double-pigtail plastic stents (DPSs) in the DPDS patients, the DPS migration rate was higher in the patients with recurrence (100% vs. 33.33%, p = 0.04). In conclusion, drainage of symptomatic PFCs with EUS-guided electrocautery-enhanced LAMS appears to be efficient and safe. Replacing LAMSs with DPSs in DPDS patients was associated with a lower recurrence rate.
Topics: Humans; Acute Disease; Drainage; Electrocoagulation; Pancreatic Diseases; Pancreatitis; Retrospective Studies
PubMed: 38443387
DOI: 10.1038/s41598-024-53785-8 -
Journal of Family Medicine and Primary... Mar 2024Auto-immune pancreatitis (AIP) is a rare benign disease commonly presented with painless obstructive jaundice and biliary obstruction with rare complications like...
Auto-immune pancreatitis (AIP) is a rare benign disease commonly presented with painless obstructive jaundice and biliary obstruction with rare complications like pseudocyst. We present a case series of two patients of AIP with unusual presentations; one case presented with periorbital swelling, jaundice, and pseudocyst, and the other case presented with abdominal pain and biliary obstruction without jaundice; both showed good response with steroids.
PubMed: 38736800
DOI: 10.4103/jfmpc.jfmpc_1931_22 -
Children (Basel, Switzerland) Jan 2024Blunt pancreatic injury (BPI) is relatively uncommon in children, and is associated with relatively high morbidity and mortality, especially if diagnosis is delayed. The... (Review)
Review
Blunt pancreatic injury (BPI) is relatively uncommon in children, and is associated with relatively high morbidity and mortality, especially if diagnosis is delayed. The aim of this report is to review the literature regarding controversial questions in the early diagnosis and management of pediatric BPI. A representative case of blunt pancreatic trauma in a six-year-old girl with delayed diagnosis and intraoperative and postoperative complications was described. A systematic search of databases and the grey literature in Scopus and Web of Science using relevant keywords was conducted. A total of 26 relevant articles published in last 5 years were found in PubMed. Although early CT performance is considered part of initial pancreatic trauma workup, the sensitivity of CT for detecting main pancreatic duct injuries in children is relatively low. MRCP and ERCP (if available) are useful for assessing ductal injury and should be performed when the status of the pancreatic duct is unclear on the CT. Most patients with low-grade pancreatic damage may be treated conservatively. Although surgery involving distal pancreatectomy remains the preferred approach for most children with high-grade pancreatic injury, there is growing evidence to suggest that non-operative management (NOM) is safe and effective. Most pancreatic pseudo cysts following NOM had relatively mild complications, and most resolved spontaneously. For those children who do require surgery, a conservative operative approach with the least risk is advocated. In conclusion, the optimal management for pediatric pancreatic trauma is controversial. Further clinical trials are required to generate clinical practice guidelines on pancreatic trauma in a child population.
PubMed: 38275445
DOI: 10.3390/children11010135 -
Revista Espanola de Enfermedades... Sep 2023A 52-year-old male diagnosed with severe acute pancreatitis developed persistent abdominal distension and intermittent emesis six weeks after treatment. Computed...
Transpapillary pancreatic duct stenting in the treatment of acute severe pancreatitis complicated by pancreatic pseudocyst compressing portal vein leading to local portal hypertension.
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.
PubMed: 37771282
DOI: 10.17235/reed.2023.9930/2023 -
Journal of Surgical Case Reports May 2024The adrenal haemangioma, a rare benign vascular tumour, is increasingly detected through abdominal imaging. Just over 70 surgical cases have been reported since 1955....
The adrenal haemangioma, a rare benign vascular tumour, is increasingly detected through abdominal imaging. Just over 70 surgical cases have been reported since 1955. Their potential large size and overlapping imaging features with adrenocortical carcinoma poses a diagnostic challenge. Adrenalectomy is often needed for a definitive diagnosis due to inconclusive imaging. We report the case of a 61-year-old female presenting with an incidental finding of a right-sided 9.5-cm adrenal mass on imaging. Due to the risk of adrenocortical carcinoma with inconclusive imaging findings, an open right adrenalectomy was performed. The patient was discharged after 6 days with no complications. Post-surgical histopathology confirmed a diagnosis of adrenal haemangioma with a secondary adrenal pseudocyst. The presence of an adrenal incidentaloma with discordant radiological features proves to be a diagnostic conundrum. Therefore, in the setting of contradictory radiology and concerning mass size, we recommend adrenalectomy for definitive diagnosis of an adrenal haemangioma.
PubMed: 38706490
DOI: 10.1093/jscr/rjae286 -
World Journal of Gastrointestinal... Oct 2023Asparaginase (ASP) is an important drug in combined chemotherapy regimens for pediatric acute lymphoblastic leukemia (ALL); ASP-associated pancreatitis (AAP) is the main...
BACKGROUND
Asparaginase (ASP) is an important drug in combined chemotherapy regimens for pediatric acute lymphoblastic leukemia (ALL); ASP-associated pancreatitis (AAP) is the main adverse reaction of ASP. Recurrent pancreatitis is a complication of AAP, for which medication is ineffective.
AIM
To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in treating recurrent pancreatitis due to AAP.
METHODS
From May 2018 to August 2021, ten children (five males and five females; age range: 4-13 years) with AAP were treated using ERCP due to recurrent pancreatitis. Clinical data of the ten children were collected, including their sex, age, weight, ALL risk grading, clinical symptoms at the onset of pancreatitis, time from the first pancreatitis onset to ERCP, ERCP operation status, and postoperative complications. The symptomatic relief, weight change, and number of pancreatitis onsets before and after ERCP were compared.
RESULTS
The preoperative symptoms were abdominal pain, vomiting, inability to eat, weight loss of 2-7 kg, and 2-9 pancreatitis onsets. After the operation, nine of ten patients did not develop pancreatitis, had no abdominal pain, could eat normally; the remaining patient developed three pancreatitis onsets due to the continuous administration of ASP, but eating was not affected. The postoperative weight gain was 1.5-8 kg. There was one case of post ERCP pancreatitis and two cases of postoperative infections; all recovered after medication.
CONCLUSION
ERCP improved clinical symptoms and reduced the incidence of pancreatitis, and was shown to be a safe and effective method for improving the management of recurrent pancreatitis due to AAP.
PubMed: 37900113
DOI: 10.4253/wjge.v15.i10.614 -
Ear, Nose, & Throat Journal Oct 2023Mucous retention cyst (MRC) is a benign and self-limited lesion that can be caused by many risk factors, including anatomical variations of the sinonasal region. This...
Mucous retention cyst (MRC) is a benign and self-limited lesion that can be caused by many risk factors, including anatomical variations of the sinonasal region. This study aims to investigate the relationship between anatomical variations and the presence of MRC. In total, 2109 sinonasal cone beam computed tomography images were evaluated for the presence of MRC, and the sinonasal anatomical regions such as the osteomeatal complex (OMC), infundibulum length, ostium height, the diameter of the ostium, the presence of accessory ostium, concha bullosa, and mucosal thickening of the maxillary sinuses. Shapiro-Wilk normality test, independent sample t-test, and chi-square test were used for statistical analysis, and < .05 was considered significant. The prevalence of MRC was 119 (5.6%) cases. The average diameter of the ostium in cases with and without MRC was 0.49 ± 0.41 mm and 0.99 ± 0.76 mm, respectively, which showed a significant inverse relationship( < .001). A significant relationship was found between the septum deviation, the ostium height, the concha bullosa, and the accessory ostium with the presence of MRC ( < .001). Sinonasal anatomical variations such as ostium diameter, ostium height, septal deviation, the presence of accessory ostium, and concha bullosa can cause MRC development, and considering that surgery may be necessary in some cases; this could be of great importance to clinicians and surgeons for treatment and prevention of development or recurrence of these pseudocysts in patients.
PubMed: 37843070
DOI: 10.1177/01455613231206284