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World Journal of Gastroenterology Aug 2019Pancreatic cysts are identified at an increasing frequency. Although mucinous cystic neoplasms represent a pre-malignant condition, the majority of these lesions do not... (Comparative Study)
Comparative Study Review
Pancreatic cysts are identified at an increasing frequency. Although mucinous cystic neoplasms represent a pre-malignant condition, the majority of these lesions do not progress to cancer. Over the last 10 years several societies have established guidelines for the diagnosis, initial evaluation and surveillance of these lesions. Here we provide an overview of five commonly used guidelines: 2015 American Gastroenterological Association, 2017 International Association of Pancreatology, American College of Gastroenterology 2018, European Study Group and American College of Radiology. We describe the similarities and differences between the methods used to formulate these guidelines, the population they target and their approaches towards initial evaluation and surveillance of cystic lesions.
Topics: Aftercare; Cystadenoma; Disease Progression; Europe; Gastroenterology; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatectomy; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst; Practice Guidelines as Topic; Radiology; Risk Assessment; Societies, Medical; United States; Watchful Waiting
PubMed: 31496620
DOI: 10.3748/wjg.v25.i31.4405 -
Cureus Feb 2021Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have... (Review)
Review
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
PubMed: 33585146
DOI: 10.7759/cureus.13230 -
Cureus Aug 2022The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical... (Review)
Review
The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections.
PubMed: 36106250
DOI: 10.7759/cureus.27803 -
Cureus Jun 2023Mesenteric cysts are detected in all age groups with almost equal incidence in both genders. Although a rare abdominal growth, it is commonly found in the fifth to...
Mesenteric cysts are detected in all age groups with almost equal incidence in both genders. Although a rare abdominal growth, it is commonly found in the fifth to seventh decades of life. These are mostly small (asymptomatic) with a 3% chance of malignant transformation. With the increase in the size of the cyst, nonspecific complaints of abdominal pain, distention, discomfort, nausea, vomiting, flatulence, constipation, or diarrhea may develop. Owing to the varied presentation and lack of pathognomonic clinical, laboratory, or imaging findings, these are difficult to diagnose. The subtype mesenteric pseudocyst is even rarer with a reported incidence of less than 1 out of 250,000 hospital admissions and can be found anywhere along the mesentery from the duodenum to the rectum. Etiology is either traumatic or infectious. Incidental diagnosis during abdominal imaging or laparotomy is common. However, it warrants immediate surgical intervention when infected or ruptured. Complete excision of the cyst is the treatment of choice. Here, we report an interesting case of a middle-aged gentleman who had been repeatedly evaluated for a tense abdomen with exudative ascites. Following decompression, he presented to us with a large obliquely mobile mass in the abdomen. The diagnosis was made by clinical and radiological findings and confirmed by histopathological examination of the intact, excised specimen post-laparotomy.
PubMed: 37476128
DOI: 10.7759/cureus.40615 -
Obstetric Medicine Mar 2023Pseudocysts of the adrenal gland are rare and in the majority of cases are non- functioning. They become symptomatic only when they are complicated by hormonal excess,... (Review)
Review
Pseudocysts of the adrenal gland are rare and in the majority of cases are non- functioning. They become symptomatic only when they are complicated by hormonal excess, rupture, haemorrhage or infection. Described here is a 26-year-old woman who developed an acute abdomen at 28 weeks of gestation due to a left adrenal haemorrhagic pseudocyst. A conservative approach was adopted, which was followed by elective term caesarean delivery with surgical intervention at the same time. The described case is unique in terms of strategizing timing and mode of management and thus minimizing the risk of prematurity and maternal morbidity associated with interval surgery.
PubMed: 37139502
DOI: 10.1177/1753495X221089210 -
Cureus May 2023Acute pancreatitis is an inflammatory process. There can be many causes of pancreatitis, which include alcohol or gallstones but can also be due to hypercalcemia,...
Acute pancreatitis is an inflammatory process. There can be many causes of pancreatitis, which include alcohol or gallstones but can also be due to hypercalcemia, infections, or hypertriglyceridemia. Most cases of pancreatitis are mild and without complications. Severe cases of pancreatitis can cause complications, including organ failure. Pseudocysts are a rare complication of pancreatitis and may require management. We present a patient with severe acute pancreatitis with organ failure admitted to the intensive care unit, stabilized, and required subsequent management of a pseudocyst with cystogastrostomy with a lumen-apposing metal stent. The patient subsequently improved and is doing well today. Herein, we present an acute severe pancreatitis case report with an extensive workup complicated by pseudocyst development. We review pancreatitis causes, including rare causes and management.
PubMed: 37323321
DOI: 10.7759/cureus.39011 -
Clinical Endoscopy Mar 2024Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The... (Review)
Review
Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.
PubMed: 38419166
DOI: 10.5946/ce.2023.271 -
International Journal of Trichology 2022Since the original report in 1992 and revised nomenclature in 2009, pseudocysts of the scalp and alopecic and aseptic nodules of the scalp (AANS), respectively, have... (Review)
Review
Since the original report in 1992 and revised nomenclature in 2009, pseudocysts of the scalp and alopecic and aseptic nodules of the scalp (AANS), respectively, have been regarded as a new entity that is rare and not understood in its pathogenesis. We observed 26 cases of AANS. Except for the extent and severity of disease, we found no single feature that justifies distinguishing AANS as a nosologic entity in its own right from dissecting cellulitis of the scalp (DCS). The scarring alopecias represent a diverse group of disorders with the potential of permanent destruction of the pilosebaceous unit and hair loss. Within the maze of varied conditions leading to scarring alopecia, the most important is to keep a neat nosologic classification in mind, based both on morphology and a pathogenic understanding. We believe that AANS represents a minor form of DCS, so far predominantly observed in patients of non-African origin, and therefore, is a disease of follicular occlusion with a favorable prognosis.
PubMed: 36081440
DOI: 10.4103/ijt.ijt_33_22 -
Case Reports in Ophthalmology 2022Hematic pseudocysts are fibrous, nonepithelial lined capsules containing blood byproducts that typically present remotely following orbital fracture hardware...
Hematic pseudocysts are fibrous, nonepithelial lined capsules containing blood byproducts that typically present remotely following orbital fracture hardware implantation. Trauma, implant migration, and tissue erosion are believed to cause hemorrhage to pool within the capsular space. Risk factors include inadequate posterior fracture reduction and use of nonporous material which prevents fibrovascular ingrowth and stabilization. Mass effect from these lesions may cause patients to present with pain, lid swelling, hyperglobus, proptosis, lid retraction, motility restriction, or blurry vision. Pseudocysts associated with fracture hardware have been misdiagnosed as tumors or in one prior case as an infection. Herein we report a unique case of hematic pseudocyst masquerading as orbital cellulitis with maxillary sinusitis. A 59-year-old man presented with periorbital pain, hyperglobus, proptosis, and ptosis 2 years after repair of an orbital floor fracture. CT demonstrated a soft tissue collection adjacent to an implant as well as maxillary sinus opacification. He did not improve with antibiotics, at which point surgery revealed a pseudocyst and its contents were removed. This report describes a unique presentation of orbital pseudocyst and summarizes the literature on this entity.
PubMed: 35702518
DOI: 10.1159/000523890