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Medicine Nov 2022Postoperative discal pseudocyst (PDP) is rare. Few studies have reported on the recurrence of PDPs, and there is a lack of understanding of their clinical features and... (Review)
Review
INTRODUCTION
Postoperative discal pseudocyst (PDP) is rare. Few studies have reported on the recurrence of PDPs, and there is a lack of understanding of their clinical features and treatment methods. This study discusses the clinical characteristics and treatment of recurrent PDPs.
PATIENT CONCERNS
A 25-year-old man presented with radiating pain and numbness in the lateral left calf and dorsum of the foot.
DIAGNOSIS
Postoperative discal pseudocyst.
INTERVENTIONS
He underwent lumbar discectomy, which provided immediate postoperative relief. However, the symptoms recurred 45 days later. Magnetic resonance imaging (MRI) showed a lesion compressing the dura and nerve roots at the site of the previous surgery. The lesion appeared hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. The patient was treated conservatively for 1 month without significant relief. He then underwent lumbar discectomy and cyst removal, which immediately relieved his symptoms. However, 27 days later, the patient again developed the same symptoms. MRI examination showed recurrence of PDP. As 1 month of conservative treatment failed to relieve the patient's symptoms, we performed posterior instrumented lumbar fusion and cyst removal.
OUTCOMES
The patient's symptoms disappeared, and have not recurred for 1 year at the time of writing.
CONCLUSIONS
PDP is a rare complication of lumbar discectomy. Repeat lumbar discectomy can effectively treat PDP, but the cyst can recur. We, for the first time, used posterior instrumented lumbar fusion to successfully treat recurrent PDP.
Topics: Male; Humans; Adult; Lumbar Vertebrae; Cysts; Diskectomy; Postoperative Period; Dura Mater
PubMed: 36397328
DOI: 10.1097/MD.0000000000031756 -
Pakistan Journal of Medical Sciences 2022Ventriculoperitoneal shunt (VPS)-related abdominal pseudocyst (APC) is a rare cause of shunt malfunction. Variable VPS function due to APC has not been described before....
Ventriculoperitoneal shunt (VPS)-related abdominal pseudocyst (APC) is a rare cause of shunt malfunction. Variable VPS function due to APC has not been described before. A 21-year-old male with hydrocephalus and bilateral VPS presented with a right-sided shunt malfunction. After a routine abdominal ultrasound (US), that proved to be unremarkable, the patient had a clinical and radiological improvement followed by a relapse. An abdominal computed tomography scan subsequently showed an APC around the peritoneal catheter tip. Laparoscopic intervention on the APC cured the shunt malfunction. We believe that the APC emptied during the compression involved while performing the abdominal US. The pseudocyst collapse led to missing it on the abdominal US and explains the short-lived clinical and radiological improvement. We introduce the concept of APC-related variable VPS function, discuss the possible mechanisms by which the pseudocyst deflated, and make suggestions toward this diagnostic problem. A collapsible abdominal pseudocyst could result in a variable ventriculoperitoneal shunt function. Starting the abdominal ultrasound examination over the location of the peritoneal catheter tip may overcome the collapse. Contrasted computed tomography is superior to ultrasound in diagnosing the pseudocyst.
PubMed: 35991274
DOI: 10.12669/pjms.38.6.6278 -
Polish Archives of Internal Medicine Aug 2023
Topics: Humans; Pancreatic Pseudocyst; Gastrointestinal Hemorrhage
PubMed: 37416974
DOI: 10.20452/pamw.16529 -
Children (Basel, Switzerland) Jan 2024Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a... (Review)
Review
Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.
PubMed: 38255387
DOI: 10.3390/children11010074 -
Cureus Aug 2022Pancreatic pseudocysts are potential sequelae of acute or chronic pancreatitis. In some cases, enzymatic degradation of the lining between a pseudocyst and the splenic...
Pancreatic pseudocysts are potential sequelae of acute or chronic pancreatitis. In some cases, enzymatic degradation of the lining between a pseudocyst and the splenic artery, or surrounding vessels, can occur, resulting in a hemorrhagic pancreatic pseudocyst. Very few of these hemorrhagic pseudocysts meet the criteria for giant pseudocysts. We discuss the case of a 30-year-old male patient with a history of alcohol abuse who presented to the hospital with a giant hemorrhagic pancreatic pseudocyst; he was admitted for expectant management and was subsequently discharged. This case report seeks to shed light on the dearth of similar cases.
PubMed: 36171855
DOI: 10.7759/cureus.28398 -
Endoscopy Dec 2023
Topics: Humans; Pancreatic Pseudocyst; Mediastinum; Endosonography; Pancreatic Cyst
PubMed: 36400044
DOI: 10.1055/a-1966-0302 -
Emergency Medicine International 2021Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical...
BACKGROUND
Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical techniques, a laparoscopic surgical approach for PPs has been conducted increasingly with comparable outcomes. The present study was conducted to compare the efficacy and safety of surgical intervention for PPs between the laparoscopic approach and the open approach.
METHODS
Databases including Cochrane Library, PubMed, and EMBASE were searched to identify studies that compared the safety and efficacy of surgical intervention for PPs between the laparoscopic approach and the open approach (until Aug 1st 2020).
RESULTS
A total of 6 studies were eligible in qualitative synthesis. The laparoscopic approach was associated with less intraoperative blood loss (MD = -69.97; 95% CI: -95.14 to -44.70, < 0.00001; =0.86 for heterogeneity) and shorter operating time (MD = -33.12; 95% CI: -62.24 to -4.00, =0.03; < 0.00001 for heterogeneity). There was no significant difference found between the two approaches regarding the success rate and the recurrence rate. The postoperative complications and mortality rates were comparable between the two approaches.
CONCLUSIONS
The laparoscopic approach for the surgical intervention of PPs is safe and efficacious with shorter-term benefits.
PubMed: 34840827
DOI: 10.1155/2021/7586338 -
Cureus Nov 2023Pancreatic pseudocysts are fluid-filled collections that can arise from acute or chronic pancreatitis and may lead to a range of complications, like rupture, infection,...
Pancreatic pseudocysts are fluid-filled collections that can arise from acute or chronic pancreatitis and may lead to a range of complications, like rupture, infection, hemorrhage, etc. Morbid obesity may further complicate the diagnosis and management of such cases. The present report describes the case of a 26-year-old superobese female (BMI: 58 kg/m²) with a pancreatic pseudocyst that presented diagnostic challenges and mimicked pulmonary embolism when the pseudocyst had ruptured. The patient initially presented with persistent biliary colic due to gallstones. Despite undergoing laparoscopic cholecystectomy, she continued to experience symptoms, including nausea, bloating, and inability to tolerate food, and lab tests showed progressive elevation of serum bilirubin levels. A huge pancreatic pseudocyst was found to be obliterating the gastric cavity and compressing the common bile duct after the patient was subjected to further radiological imaging. While waiting to be transferred to a tertiary center with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic stenting, and other facilities, she suddenly experienced severe symptoms, like shortness of breath, upper abdominal/chest pain, tachycardia (heart rate: 140 beats per min), dizziness, and low oxygen saturation. The likelihood of pulmonary embolism (PE) was very high in the differential diagnoses, but computer tomography pulmonary angiography (CTPA) ruled out PE. Based on imaging and clinical assessment, rupture of the pancreatic pseudocyst was diagnosed. The patient was subsequently managed in a tertiary hospital endoscopically. This case highlights the challenges of diagnosing and managing pancreatic pseudocysts in extremely obese patients. It also underscores the role of a multidisciplinary approach and vigilant clinical attention to prevent misdiagnosis and optimize outcomes.
PubMed: 38161865
DOI: 10.7759/cureus.49643 -
International Journal of Surgery Case... Sep 2021Splenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon...
INTRODUCTION AND IMPORTANCE
Splenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of large splenic pseudocyst without history of previous abdominal trauma.
CASE PRESENTATION
A 56 year old male patient, presented with symptoms of pain in the left side of middle back and discomfort in the left hypochondrium for few months. His physical examination was unremarkable. The abdominal Ultrasound and contrast-enhanced Computed tomography showed a large splenic cyst occupying most of the splenic parenchyma. Echinococcus multilocularis antibody test was negative. The differential diagnosis of this case included non-parasitic splenic cysts. The patient underwent elective exploratory laparoscopy which was converted to laparotomy with total splenectomy. Histopathological examination of the specimen revealed a splenic pseudocyst.
CLINICAL DISCUSSION
The splenic cyst in this case was symptomatic due to its large size. It was hard to elicit an etiology as there was no history of abdominal trauma, infection, or degenerative disease. The main factors in selecting either conservative or radical surgical approach for such cases are the cyst location, cyst size, and the residual splenic parenchyma.
CONCLUSION
The goal of splenic pseudocysts treatment is to relieve symptoms and avoid complications. Partial splenectomy is the recommended procedure when the size and location of the cyst allow preservation of at least 25% of splenic parenchyma. Otherwise, Total splenectomy is unavoidable.
PubMed: 34418805
DOI: 10.1016/j.ijscr.2021.106317 -
Radiology Case Reports Jan 2023A splenic pseudocyst is an encapsulated mature collection located within the splenic tissues. It is usually asymptomatic and is detected incidentally during either...
A splenic pseudocyst is an encapsulated mature collection located within the splenic tissues. It is usually asymptomatic and is detected incidentally during either radiological workup or laparoscopy for other reasons. Our patient is a 66-year-old male presenting with a history of weight loss, early satiety, and constipation, found to have a splenic pseudocyst communicating with a preexisting pancreatic cyst. Cystic lesions of the spleen can be divided into primary and secondary types. Secondary splenic cysts (pseudocysts) are residues of either earlier infection, trauma, or infarction. Management approaches to splenic cysts are either conservative or surgical according to the symptoms and size of these cysts. Most splenic cysts are discovered incidentally either during radiological workup or laparoscopy. Such entities require the combined effort of surgeons, gastroenterologists, and radiologists to provide the maximum care for these patients.
PubMed: 36340237
DOI: 10.1016/j.radcr.2022.10.013