-
Pancreatology : Official Journal of the... Jan 2021Pancreatic ascites (PA) and pleural effusion (PPE) are rarely encountered in children. They develop due to disruption of the pancreatic duct (PD) or leakage from an...
BACKGROUND
Pancreatic ascites (PA) and pleural effusion (PPE) are rarely encountered in children. They develop due to disruption of the pancreatic duct (PD) or leakage from an associated pancreatic fluid collection (PFC). The literature on childhood PA/PPE and its management is scarce.
METHODS
A retrospective review of children with PA/PPE diagnosed and managed at our center over the last 4 years was performed. The clinical, biochemical, radiological and management profiles were analyzed. Conservative management included nil per oral, octreotide and drainage using either percutaneous catheter or repeated paracentesis. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) and transpapillary stenting.
RESULTS
Of the 214 children with pancreatitis, 15 (7%) had PA/PPE. Median age was 9 years with a third under 2 years. Median ascitic fluid amylase was 8840 U/L and all had elevated protein (>2.5 g/dl) and low serum ascites-albumin gradient ascites (<1.1). While PA/PPE was the first manifestation of underlying chronic pancreatitis (CP) in 10 children (67%), trauma was seen in 4 (26%) and hypertriglyceridemia in 1 (7%). On imaging, PD disruption could be identified in 10 (67%) children. ERCP and stenting was done in 10 children. Conservative management alone (n = 4) and endotherapy (n = 10) was successful in 93% with only one requiring surgery. The younger children (n = 4), were managed conservatively and only 1 of them required surgery. Resolution of PA/PPE was achieved in all with no recurrences.
CONCLUSIONS
Conservative management and ERCP plus transpapillary stenting results in resolution of majority of pediatric PA/PPE. Children presenting with PA/PPE needs to be evaluated for CP.
Topics: Ascites; Child; Child, Preschool; Drainage; Female; Humans; Infant; Male; Pancreatic Ducts; Pancreatitis; Pleural Effusion; Retrospective Studies
PubMed: 33349510
DOI: 10.1016/j.pan.2020.12.010 -
International Journal of Molecular... Aug 2021The production of pancreatic β cells is the most challenging step for curing diabetes using next-generation treatments. Adult pancreatic endocrine cells are thought to...
The production of pancreatic β cells is the most challenging step for curing diabetes using next-generation treatments. Adult pancreatic endocrine cells are thought to be maintained by the self-duplication of differentiated cells, and pancreatic endocrine neogenesis can only be observed when the tissue is severely damaged. Experimentally, this can be performed using a method named partial duct ligation (PDL). As the success rate of PDL surgery is low because of difficulties in identifying the pancreatic duct, we previously proposed a method for fluorescently labeling the duct in live animals. Using this method, we performed PDL on neurogenin3 (Ngn3)-GFP transgenic mice to determine the origin of endocrine precursor cells and evaluate their potential to differentiate into multiple cell types. Ngn3-activated cells, which were marked with GFP, appeared after PDL operation. Because some GFP-positive cells were aligned proximally to the duct, we hypothesized that Ngn3-positive cells arise from the pancreatic duct. Therefore, we next developed an in vitro pancreatic duct culture system using Ngn3-GFP mice and examined whether Ngn3-positive cells emerge from this duct. We observed GFP expressions in ductal organoid cultures. GFP expressions were correlated with Ngn3 expressions and endocrine cell lineage markers. Interestingly, tuft cell markers were also correlated with GFP expressions. Our results demonstrate that in adult mice, Ngn3-positive endocrine precursor cells arise from the pancreatic ducts both in vivo and in vitro experiments indicating that the pancreatic duct could be a potential donor for therapeutic use.
Topics: Animals; Antigens, Differentiation; Basic Helix-Loop-Helix Transcription Factors; Green Fluorescent Proteins; Insulin-Secreting Cells; Mice; Mice, Transgenic; Nerve Tissue Proteins; Organoids; Pancreatic Ducts; Stem Cells
PubMed: 34445257
DOI: 10.3390/ijms22168548 -
Revista Espanola de Enfermedades... Sep 2023Due to low incidence rate of pancreatic duct stones,Authoritative consensus has not been reached regarding therapeutic choices in clinical practice. This article...
Due to low incidence rate of pancreatic duct stones,Authoritative consensus has not been reached regarding therapeutic choices in clinical practice. This article reports the treatment of a young woman with chronic pancreatitis complicated with refractory multiple pancreatic duct stones, which provides clinical experience for treatment and provides a new way to study the pathogenesis of chronic pancreatitis complicated with pancreatic duct stones.
Topics: Female; Humans; Pancreatic Ducts; Lithotripsy; Pancreatic Diseases; Pancreatitis, Chronic; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 36562526
DOI: 10.17235/reed.2022.9378/2022 -
Expert Review of Gastroenterology &... Feb 2022In patients with acute necrotizing pancreatitis (ANP), parenchymal necrosis may involve the pancreatic duct, isolating a segment of the pancreas that remains functional... (Review)
Review
INTRODUCTION
In patients with acute necrotizing pancreatitis (ANP), parenchymal necrosis may involve the pancreatic duct, isolating a segment of the pancreas that remains functional but drains its secretions into the peripancreatic fluid collections, leading to disconnected pancreatic duct syndrome (DPDS). DPDS is an important complication of ANP associated with long-term morbidity and mortality. Unfortunately, this critical entity is under-recognized by radiologists. Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for diagnosing and treating such patients. However, considering the invasiveness of the ERCP, a noninvasive diagnosis based on radiological tests is desirable. Radiological literature concerning the diagnosis of DPDS is scarce, and there is substantial ambiguity regarding the radiological definitions of DPDS.
AREAS COVERED
Considering the scarcity of published literature regarding the reliable radiologic diagnosis of DPDS, we performed a thorough review of the existing literature to identify definitions and features of this entity on computed tomography (CT) and magnetic resonance imaging (MRI).
EXPERT OPINION
Existing literature regarding radiologic diagnosis of DPDS was reviewed and analyzed and a comprehensive imaging definition of DPDS was proposed.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Magnetic Resonance Imaging; Pancreatic Ducts; Pancreatitis, Acute Necrotizing; Syndrome; Tomography, X-Ray Computed
PubMed: 35051345
DOI: 10.1080/17474124.2022.2031978 -
Gastrointestinal Endoscopy Nov 2022
Topics: Humans; Pancreatic Ducts; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 35931140
DOI: 10.1016/j.gie.2022.07.023 -
Journal of Hepato-biliary-pancreatic... Sep 2021
Topics: Abdominal Injuries; Humans; Pancreatic Diseases; Pancreatic Ducts
PubMed: 34009750
DOI: 10.1002/jhbp.973 -
Abdominal Radiology (New York) Aug 2020To evaluate the pancreatic duct cutoff sign in detecting pancreatic adenocarcinoma using CT and MRI.
PURPOSE
To evaluate the pancreatic duct cutoff sign in detecting pancreatic adenocarcinoma using CT and MRI.
METHODS
A retrospective analysis of patients with a pancreatic duct (PD) cutoff sign on CT or MRI from 2000 to 2019 was performed. The primary outcome measured was the presence or absence of a malignant pancreatic tumor. Variables evaluated included imaging characteristics of patients with a malignant versus non-malignant cause of duct cutoff and included PD size and PD-to-parenchyma ratio, contour abnormality, abnormal enhancement, diffusion abnormality, and upstream parenchymal atrophy.
RESULTS
Seventy-two patients (44:28 M:F, mean age 64 years) were identified with a PD cutoff sign. Fifty-eight percent (42/72) of these patients were diagnosed with malignancy, 62% (26/42) of whom were diagnosed with pancreatic ductal adenocarcinoma. In patients diagnosed with a non-malignant cause of duct cutoff, 37% (11/30) were diagnosed with chronic pancreatitis. Eighty-eight percent (37/42) of patients with malignant causes and 33% (10/30) of patients with non-malignant causes were noted to have an associated mass on imaging. The presence of contour abnormality, diffusion abnormality, or abnormal enhancement at the level of the pancreatic cutoff was significantly higher in patients with malignancy (p < 0.05). There was no difference between groups in location of the pancreatic duct cutoff, degree of pancreatic duct dilatation, PD-to-parenchyma ratio, or presence of upstream atrophy.
CONCLUSION
Abrupt cutoff of the pancreatic duct was associated with an increased likelihood of detecting malignancy. All patients who demonstrate this sign should undergo expedited workup with dedicated MRI and EUS with biopsy.
Topics: Adenocarcinoma; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Middle Aged; Pancreatic Ducts; Pancreatic Neoplasms; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 32444890
DOI: 10.1007/s00261-020-02582-8 -
Digestive Diseases and Sciences May 2021
Topics: Humans; Pancreatic Ducts; Pancreatic Fistula
PubMed: 32794056
DOI: 10.1007/s10620-020-06538-2 -
Japanese Journal of Radiology Jun 2020Researchers have examined the possibility of studying pancreatic and biliary flow and using to aid the pathological evaluation of pancreaticobiliary diseases. Recently,... (Review)
Review
Researchers have examined the possibility of studying pancreatic and biliary flow and using to aid the pathological evaluation of pancreaticobiliary diseases. Recently, a new method using MR imaging (MRI) has been developed for the direct visualization of pancreatic juice flow, based on a spin labeling technique. This technique enables direct visualization of pancreatic or bile duct juice flow and has various clinical applications relating to pancreaticobiliary disease. This review discusses the principle of pancreatic and biliary flow MRI with spin labeling and typical application examples such as the evaluation of the exocrine function of the pancreas in cases of chronic pancreatitis and the visualization of pancreatic juice reflux into the bile duct. Moreover other application is also discussed.
Topics: Bile Duct Diseases; Bile Ducts; Humans; Magnetic Resonance Imaging; Pancreatic Diseases; Pancreatic Ducts
PubMed: 32157559
DOI: 10.1007/s11604-020-00940-6 -
PloS One 2023Although main pancreatic duct dilatation and pancreatic cysts are risk factors for developing pancreatic cancer, limited data exist regarding these findings in relatives...
Although main pancreatic duct dilatation and pancreatic cysts are risk factors for developing pancreatic cancer, limited data exist regarding these findings in relatives and spouses of pancreatic cancer patients. The frequency of these findings was examined using long-term follow-up data and transabdominal ultrasonography focusing on the pancreas. We prospectively enrolled 184 relatives and spouses of pancreatic cancer patients and performed special pancreatic ultrasonography to detect main pancreatic duct dilatation and pancreatic cysts. First-degree relatives (148 participants) of patients with pancreatic cancer were significantly younger than the spouses (36 participants; 41 vs. 65 years old). The frequency of ultrasonographic findings was significantly different between the relative (8.8%) and spouse (33.3%) groups. Main pancreatic duct dilatation and pancreatic cysts were observed in seven (4.7%) and seven (4.7%) participants in the relative group, and in nine (25.0%) and five (13.9%) participants in the spouse group, respectively. On multivariate analysis, age was an independent risk factor for the ultrasonographic findings. The frequency of ultrasonographic findings was significantly higher in spouses than in first-degree relatives of patients with pancreatic cancer and was strongly influenced by the age gap between the groups. Main pancreatic duct dilatation was frequently observed, especially in the spouse group.
Topics: Humans; Aged; Spouses; Dilatation; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatic Cyst; Gastrointestinal Diseases; Dilatation, Pathologic
PubMed: 36630426
DOI: 10.1371/journal.pone.0280403