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Cureus Feb 2023Pancreatic pseudocyst (PPC) and walled-off necrosis (WON) develop as late complications of acute pancreatitis that have been historically managed surgically. With the... (Review)
Review
Pancreatic pseudocyst (PPC) and walled-off necrosis (WON) develop as late complications of acute pancreatitis that have been historically managed surgically. With the advancement in endoscopic equipment and the evolution of endoscopic surgery, the management of PPC has evolved considerably in recent years from surgical drainage to transmural endoscopic drainage. Till the end of the 20th century, a limited number of surgeons performed laparoscopic drainage of PPCs. Due to the steep learning curve needed for performing advanced laparoscopic suturing, a majority of studies conducted during this period have compared open surgical drainage with endoscopy. The efficacy of these modalities has largely been evaluated using retrospective studies and a few meta-analyses particularly due to the low-volume caseload of individual centres. Also, these studies include PPC and WON together in data analysis despite WON being a distinct entity. There are limited prospective well-designed clinical trials comparing endoscopic and laparoscopic management of pure PPCs. There is also a lack of specific recommendations for the management of PPCs. Considerable overlap of indications between these two modalities exists. The efficacy of endoscopic transmural drainage as an index intervention when compared to laparoscopy has not been proven in the research literature. Previous studies have not considered multiple endoscopic interventions within a four-week period of index intervention as a failure. We reviewed the literature using appropriate MeSH terms on the PubMed search engine for articles comparing laparoscopic and endoscopic transmural management of PPCs according to our inclusion and exclusion criteria. Seven articles were identified for inclusion in the qualitative synthesis. This scoping review was conducted to answer some pertinent unanswered questions, identify gaps in knowledge regarding the laparoscopic vs endoscopic management of PPCs, and guide further research.
PubMed: 36909096
DOI: 10.7759/cureus.34694 -
Andes Pediatrica : Revista Chilena de... Apr 2024Molluscum contagiosum (MC) is a common viral infection in children, immunocompromised, and sexually active adults. Its usual clinical presentation is 2-5 mm, whitish or... (Review)
Review
Molluscum contagiosum (MC) is a common viral infection in children, immunocompromised, and sexually active adults. Its usual clinical presentation is 2-5 mm, whitish or skin-colored papules, with a shiny surface and central umbilication, generally clustered and randomly distributed over the skin surface. Dermoscopy reveals yellowish-white polylobulated structures with peripheral telangiectasia. Diagnosis is usually clinical supported by dermoscopy. However, in some cases, inflammatory manifestations can be associated with this infection and can mimic other dermatological conditions, making the diagnosis difficult and leading to unnecessary treatments. The objective of this article is to describe the main skin reactions associated with MC infection in order to provide a diagnostic and initial management tool for clinicians dealing with these conditions. Reported manifestations include the BOTE sign, perilesional eczema, Gianotti-Crosti syndrome-like reaction, ID reaction, erythema annulare centrifugum, erythema multiforme, folliculitis, white halo, and atypical manifestations (giant, disseminated, necrotic, polypoidal, and nodular lesions, pseudocysts, abscesses). In pediatric patients with the clinical manifestations described above, infection by molluscum contagiosum pox virus should be considered among the differential diagnoses, and referral to a dermatologist should be made in selected cases.
Topics: Humans; Molluscum Contagiosum; Child; Diagnosis, Differential; Dermoscopy; Skin Diseases
PubMed: 38801360
DOI: 10.32641/andespediatr.v95i2.5034 -
Przeglad Gastroenterologiczny 2021According to the literature exocrine pancreatic insufficiency is relatively common among patients with diabetes mellitus (DM). Pseudocysts are the most common cystic...
INTRODUCTION
According to the literature exocrine pancreatic insufficiency is relatively common among patients with diabetes mellitus (DM). Pseudocysts are the most common cystic lesions and may be formed in the setting of acute or chronic pancreatitis. However, whether DM is involved or not in pancreatic cyst formation is still not well established.
AIM
To investigate the frequency and risk factors of cystic lesions in diabetic patients.
MATERIAL AND METHODS
One hundred and sixty-one patients with DM, with no previous history of pancreatic diseases, were prospectively included in the study. Endosonography followed by fine needle aspiration biopsy was then performed.
RESULTS
Finally, 33 of 161 patients (20.5%) were recognized with cystic lesions of the pancreas. Among them 5 patients were classified as cystic neoplasms, and 28 as pseudocysts. In the group of patients with pseudocysts, cystic lesions were significantly more prevalent in individuals with DM lasting less than 3 years. Prevalence of cystic lesions was significantly higher in metformin users in comparison to other diabetic patients ( < 0.05). Cystic lesions were more frequent in patients above 50 years of age ( < 0.05).
CONCLUSIONS
The prevalence of cystic lesions in the diabetic population is higher than in the general population. DM seems to play a major role in the process of cyst development, especially in patients without previous history of pancreatitis. Higher prevalence of cystic lesions in early diabetes seems to be the first stage of pancreatic injury. The exact role of diabetes duration and type of treatment should be established.
PubMed: 33986890
DOI: 10.5114/pg.2020.96080 -
Arquivos Brasileiros de Cirurgia... 2023Pancreatic cystic lesions are a group of pancreatic neoplasms with different behavior and risk of malignancy. Imaging diagnosis and differentiation of these lesions...
BACKGROUND
Pancreatic cystic lesions are a group of pancreatic neoplasms with different behavior and risk of malignancy. Imaging diagnosis and differentiation of these lesions remain a challenge.
AIMS
The aim of this study was to evaluate the agreement between computed tomography and/or magnetic resonance imaging and post-operative pathologic diagnoses of Pancreatic cystic lesions in a University Hospital of São Paulo State.
METHODS
A total of 39 patients with surgically diagnosed Pancreatic cystic lesions were enrolled, as a study cohort from 2009 to 2019. Preoperative radiological and final pathological diagnosis was correlated to measure computed tomography and/or magnetic resonance imaging diagnostic. Pancreatic adenocarcinoma, choledochal pancreatic cyst, mucinous cystadenoma, serous cystadenoma, intraductal papillary mucinous neoplasms, and pancreatic pseudocyst were classified as neoplastic cysts.
RESULTS
It was noted that 27 patients (69.23%) had preoperative computed tomography and magnetic resonance imaging, 11 patients (28.20%) had preoperative computed tomography only, and 1 patient had preoperative magnetic resonance imaging only. The values for diagnoses made only with computed tomography (p=0.47) and from the combination of computed tomography+magnetic resonance imaging (p=0.50) did also point to moderate agreement with the anatomopathological findings. The values pointed to a fair agreement for the diagnosis of mucinous cystadenoma (p=0.3), moderate agreement for intraductal papillary mucinous neoplasms (p= 0.41), good agreement for serous cystadenoma (p=0.79), and excellent agreement for choledochal pancreatic cyst (p=1), pancreatic pseudocyst (p=0.84), and Frantz tumor (p=1) (p<0.05).
CONCLUSIONS
The findings of computed tomography and/or magnetic resonance imaging have an equivalent diagnostic agreement with an anatomopathological diagnosis for differentiating benign from malignant Pancreatic cystic lesions and in suggesting a specific diagnosis. There is no statistical difference between the use of computed tomography alone and computed tomography+magnetic resonance imaging in the improvement of diagnostic accuracy.
Topics: Humans; Pancreatic Cyst; Pancreatic Pseudocyst; Pancreatic Neoplasms; Cystadenoma, Mucinous; Cystadenoma, Serous; Adenocarcinoma; Brazil; Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 37255104
DOI: 10.1590/0102-672020230017e1735 -
Revista Espanola de Enfermedades... Oct 2023Pancreatic pseudocysts are very common cystic lesions after any inflammatory process of the pancreas. The majority are asymptomatic and only a small minority present...
Pancreatic pseudocysts are very common cystic lesions after any inflammatory process of the pancreas. The majority are asymptomatic and only a small minority present complications or produce compression symptoms. However, this small minority must receive treatment, which depending on the clinical situation must be endoscopic, surgical or interventional radiology. We present the case of a patient with a ruptured pseudocyst for whom we avoided surgical treatment and opted for conservative treatment, with good evolution.
PubMed: 37882234
DOI: 10.17235/reed.2023.9912/2023 -
BMJ Case Reports May 2023Cystic lesions of the adrenal glands are relatively uncommon and most of them are clinically silent. Though rarely associated with malignant changes, they may carry...
Cystic lesions of the adrenal glands are relatively uncommon and most of them are clinically silent. Though rarely associated with malignant changes, they may carry clinically detrimental consequences if misdiagnosed. Cystic adrenal lesions exhibit a broad histomorphological spectrum, ranging from pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. Here we present the case of a young woman with left-sided abdominal pain and contrast-enhanced CT showing a 10.4×7.7×7.8 cm fluid-filled left suprarenal lesion. The patient underwent exploratory laparotomy with cyst excision, and the histopathological examination of the specimen revealed a pseudocyst of the left adrenal gland. Despite being rare, usually benign and asymptomatic, the diagnosis and management of these cystic lesions of the adrenal glands are often unclear. Any functional lesion, potentially malignant lesion or lesion more than 5 cm deserves surgical management, whereas others can be managed conservatively.
Topics: Female; Humans; Adrenal Gland Diseases; Adrenal Glands; Tomography, X-Ray Computed; Epidermal Cyst; Diagnosis, Differential
PubMed: 37142280
DOI: 10.1136/bcr-2022-254535 -
International Journal of Surgery Case... Aug 2022Chylous ascites is the collection of milky-like fluid rich in triglycerides within the peritoneal cavity. It results from disruption of normal intestinal lymphatic flow....
INTRODUCTION
Chylous ascites is the collection of milky-like fluid rich in triglycerides within the peritoneal cavity. It results from disruption of normal intestinal lymphatic flow. It is caused mainly by congenital anomalies, trauma, and malignancy. Chylous ascites following blunt abdominal injury is uncommon in pediatrics. Chyle duct and pancreatic injuries present a rare clinical sequela yet to be reported in the literature. Conservative management is the mainstay of treating chyle duct injuries, reserving invasive measures for unique circumstances.
CASE PRESENTATION
A case of an eleven-year-old female who suffered blunt thoracoabdominal trauma and sustained injuries to the chest, pancreas, and chyle duct. She had clinical signs of peritonism and decreased air entry on the right hemithorax. While she underwent abdominal exploration, the chylous ascites eventually resolved on conservative management, and the pancreatic pseudocyst was later drained percutaneously.
DISCUSSION
Chylous ascites and pancreatic pseudocyst is uncommon in pediatrics. While surgery is indicated in selected cases, a conservative approach is advocated in managing lymphatic leaks. Diet with low triglycerides and high protein is advocated to decrease lymph production. Treatment of pancreatic pseudocyst varies from conservative (watchful waiting) to drainage measures.
CONCLUSION
Although chylous ascites is not expected following trauma, has to be considered among differential free peritoneal fluid. Pancreatic injuries are common but difficult to diagnose. CT and MRCP are preferred modalities for diagnosing pancreatic injuries. While dietary modification and drainage of the chylous ascites were the mainstays in managing chyle duct injury, pancreatic pseudocyst resolved after percutaneous drainage.
PubMed: 35839653
DOI: 10.1016/j.ijscr.2022.107406 -
Diagnostics (Basel, Switzerland) Aug 2022Endoscopic ultrasonography (EUS) is the most accurate imaging modality for the evaluation of different types of pancreatic cystic lesions. Our aim was to analyze EUS...
Endoscopic ultrasonography (EUS) is the most accurate imaging modality for the evaluation of different types of pancreatic cystic lesions. Our aim was to analyze EUS images of pancreatic cystic lesions using an image processing software. We specified the echogenicity of the lesions by measuring the gray value of pixels inside the selected areas. The images were divided into groups (serous cystic neoplasm /SCN/, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms /Non-SCN/ and Pseudocyst) according to the pathology results of the lesions. Overall, 170 images were processed by the software: 81 in Non-SCN, 30 in SCN and 59 in Pseudocyst group. The mean gray value of the entire lesion in the Non-SCN group was significantly higher than in the SCN group (27.8 vs. 18.8; p < 0.0005). The area ratio in the SCN, Non-SCN and Pseudocyst groups was 57%, 39% and 61%, respectively; significantly lower in the Non-SCN group than in the SCN or Pseudocyst groups (p < 0.0005 and p < 0.0005, respectively). The lesion density was also significantly higher in the Non-SCN group compared to the SCN or Pseudocyst groups (4186.6/mm2 vs. 2833.8/mm2 vs. 2981.6/mm2; p < 0.0005 and p < 0.0005, respectively). The EUS image analysis process may have the potential to be a diagnostic tool for the evaluation and differentiation of pancreatic cystic lesions.
PubMed: 36140506
DOI: 10.3390/diagnostics12092105 -
Gastroenterology Feb 2022
Topics: Carcinoma in Situ; Carcinoma, Pancreatic Ductal; Cholangiopancreatography, Magnetic Resonance; Cystadenoma; Disease Management; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Incidental Findings; Magnetic Resonance Imaging; Pancreatic Cyst; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms; Pancreatic Pseudocyst; Precancerous Conditions; Risk Assessment; Tomography, X-Ray Computed
PubMed: 34678216
DOI: 10.1053/j.gastro.2021.09.073 -
Immunity, Inflammation and Disease Dec 2022There have been many reports on biomarkers for predicting the severity of acute pancreatitis (AP), but few studies on biomarkers for predicting complications; some...
BACKGROUND
There have been many reports on biomarkers for predicting the severity of acute pancreatitis (AP), but few studies on biomarkers for predicting complications; some simple and inexpensive indicators, in particular, are worth exploring.
METHODS
We retrospectively collected clinical data of 809 AP patients, including medical history and results of routine blood tests, and grouped them according to the occurrence of complications. Differences in clinical characteristics between groups with and without complications were compared using t-test or χ test. Receiver operating curve (ROC) and area under the curve were calculated to evaluate the ability of predicting the occurrence of complications for the routine blood parameters with statistical differences. Then, through univariate and multivariate analyses, independent risk factors closely associated with complications were identified. Finally, we built a three-parameter prediction system and evaluated its ability to predict AP complications.
RESULTS
Compared with the group without complications, the patients in the complication group had higher white blood cells, neutrophils, C-reactive protein, and erythrocyte sedimentation rate (ESR), and lower red blood cells and hemoglobin (Hb) (all p < .05), and most of them had severe pancreatitis. In addition, pseudocysts were more common in patients with alcoholic etiology, recurrence, low BMI, and high platelet (PLT) and plateletocrit. Acute respiratory failure was more common in patients with first onset and high mean PLT volume (MPV). Sepsis was more common in patients with lipogenic etiology, high MPV, and low lymphocytes. Infectious pancreatic necrosis was more common in patients with alcoholic etiology. Acute renal failure was more common in patients with monocytes and high MPV and low PLT. Multivariate analysis showed that PLT and ESR were risk factors for pseudocyst development. The ROC showed that the combination of Hb, PLT and ESR had a significantly higher predictive ability for pseudocyst than the single parameter.
CONCLUSION
Routine blood parameters can be used to predict the complications of AP. A predictive model combining ESR, PLT, and Hb may be an effective tool for identifying pseudocysts in AP patients.
Topics: Humans; Pancreatitis; Acute Disease; Retrospective Studies; Hospitalization; Neutrophils
PubMed: 36444624
DOI: 10.1002/iid3.747