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Journal of Laparoendoscopic & Advanced... Mar 2022Management of symptomatic pancreatic pseudocysts poses a unique challenge to minimally invasive surgeons. Despite the predominance of endoscopic management of...
Management of symptomatic pancreatic pseudocysts poses a unique challenge to minimally invasive surgeons. Despite the predominance of endoscopic management of pancreatic pseudocysts, the laparoscopic approach remains a critical skill in the armamentarium of surgeons. This report details a laparoscopic intragastric approach to create a pancreatic cystgastrostomy using intraoperative ultrasound and endoscopy. Laparoendoscopic techniques for pancreatic pseudocysts are still required in selective cases when endoscopic management is not available or fails. Using this technique provides patients with same clinical benefits of an endoscopic approach.
Topics: Drainage; Endoscopy, Gastrointestinal; Gastrostomy; Humans; Laparoscopy; Pancreatic Pseudocyst
PubMed: 34962154
DOI: 10.1089/lap.2021.0801 -
Human Pathology Jul 1989Adrenal pseudocysts are cystic lesions arising within the adrenal gland surrounded by a fibrous tissue wall devoid of a recognizable lining layer. This study comprised...
Adrenal pseudocysts are cystic lesions arising within the adrenal gland surrounded by a fibrous tissue wall devoid of a recognizable lining layer. This study comprised eight adrenal pseudocysts surgically excised at the Massachusetts General Hospital. The median age of the patients was 41 years. Seven of the eight individuals were women. There was no apparent etiologic relationship to prior trauma or pregnancy. Half of the patients described symptoms that resolved following pseudocyst removal. The remaining individuals were asymptomatic with adrenal pseudocysts discovered incidentally during the work up of other medical problems. Adrenal pseudocyst size ranged from 1.8 to 10 cm. Pseudocyst size did not correlate with the presence of symptoms. The histologic and immunohistochemical findings in this study suggest that at least some adrenal pseudocysts are of vascular origin. In two lesions, small foci of residual cells lining the inner pseudocyst wall were found that expressed factor VIII antigen (also Ulex Europaeus lectin in one case) but not vimentin, keratin, or epithelial membrane antigen. In both cases, abundant elastic tissue was present in the pseudocyst wall, and in one lesion, adrenal vein smooth muscle was present as well. In both cases, dilated sinusoids were found at the periphery of the pseudocysts and, in one lesion, the sinusoids appeared to coalesce to form the pseudocyst cavity. In the majority of the remaining six cases there was also some histologic evidence to suggest a vascular origin. In five and three cases, respectively, abundant elastic tissue and adrenal vein smooth muscle were found within the pseudocyst wall. In two lesions, both elastic tissue and smooth muscle were present. In addition, adrenal sinusoids were prominently dilated at the periphery of four pseudocysts and, in one case, the sinusoids appeared to coalesce to form the pseudocyst cavity.
Topics: Adrenal Gland Diseases; Adrenal Glands; Adult; Cysts; Elastic Tissue; Female; Humans; Immunohistochemistry; Male; Middle Aged; Muscle, Smooth, Vascular; Sex Factors
PubMed: 2737661
DOI: 10.1016/0046-8177(89)90153-6 -
Journal of Clinical Gastroenterology Oct 1991A sizable number of pancreatic pseudocysts resolve spontaneously. Some, however, require intervention. Surgery was the only option available for many years. Recently,...
A sizable number of pancreatic pseudocysts resolve spontaneously. Some, however, require intervention. Surgery was the only option available for many years. Recently, however, newer methods, such as percutaneous drainage and endoscopic cystotenterostomy have been used. Percutaneous drainage is inexpensive, has a low complication rate, and is done under local anesthesia. The recurrence rate is high with a one-time needle aspiration; this rate can be reduced to less than 10% by using an indwelling catheter. All these factors tend to make percutaneous continuous catheter drainage the first choice in the management of pseudocysts that require intervention. Experience with the endoscopic technique is still limited.
Topics: Catheterization; Drainage; Endoscopy, Digestive System; Enterostomy; Humans; Pancreas; Pancreatic Pseudocyst; Radiology, Interventional; Suction
PubMed: 1744383
DOI: No ID Found -
International Archives of... Apr 2019Pseudocyst of the pinna is a rare condition that occurs when fluid accumulates in the intercartilagenous space of the auricle. The main goal when treating this...
Pseudocyst of the pinna is a rare condition that occurs when fluid accumulates in the intercartilagenous space of the auricle. The main goal when treating this condition is to keep acceptable cosmetic results with no recurrence rate. To demonstrate the superior impact of incision and drainage of auricular pseudocysts with the insertion of a catheter drain and daily irrigation as the treatment of this condition. A total of 42 patients with auricular pseudocysts were enrolled in the present study in the period between May 2011 and May 2017. All of the patients were treated with incision and drainage with compression. The average follow-up time reached ∼ 6 months in all of the cases. All of the patients had satisfactory cosmetic results with no recurrence and no complications. Among the different methods of surgical treatment of pseudocyst of the pinna, incision and drainage with daily irrigation is a significantly efficient method both for the eradication of auricular pseudocysts and for good cosmetic results.
PubMed: 30956702
DOI: 10.1055/s-0038-1676124 -
Gastroenterology Clinics of North... Mar 2012Techniques of endoscopic pseudocyst management continue to evolve, but the principles of proper patient selection and careful consideration of the available therapeutic... (Review)
Review
Techniques of endoscopic pseudocyst management continue to evolve, but the principles of proper patient selection and careful consideration of the available therapeutic options remain unchanged. Endoscopic management is considered first-line therapy in the treatment of symptomatic pseudocysts. Clinicians should be vigilant in the evaluation of all peripancreatic fluid collections to exclude the presence of a pancreatic cystic neoplasm and avoid draining an immature collection. Expectant management with periodic observation should be considered for the minimally symptomatic patients, even after the traditional 6 weeks of maturation. Further, symptoms, complications, and expansion on serial imaging should prompt intervention by endoscopic, surgical, or percutaneous methods. Pseudocysts should only be punctured when the wall has had sufficient time to mature and after pseudoaneurysm has been ruled out by careful imaging. Small to moderately sized pseudocysts (< 4–6 cm) that communicate with the pancreatic duct are good candidates for endoscopic transpapillary stenting. For larger lesions requiring transmural drainage, EUS guidance is preferable, but good results can be achieved with ENL. EUS may be particularly useful in permitting drainage in patients with suspected perigastric varices or if an endoscopically visible bulge is not apparent. Necrosis is a significant factor for a worse outcome; aggressive debridement with nasocystic or percutaneous endoscopic gastrostomy-cystic catheter lavage plus manual endoscopic techniques for clearing debris should be used. Endoscopic failure, especially in cases with significant necrosis, should be managed operatively. Percutaneous drainage is a good option for immature infected pseudocysts or in patients who are not optimal candidates for other procedures. Close cooperation between endoscopists, surgeons, interventional radiologists, and other healthcare providers is paramount in successfully managing these patients.
Topics: Diagnosis, Differential; Drainage; Endoscopy, Digestive System; Endosonography; Humans; Pancreatic Neoplasms; Pancreatic Pseudocyst
PubMed: 22341249
DOI: 10.1016/j.gtc.2011.12.007 -
APSP Journal of Case Reports 2015Pancreatic pseudocysts in children are not uncommon. Non-resolving pseudocysts often require surgical intervention. Endoscopic cystogastrostomy is a minimally invasive...
Pancreatic pseudocysts in children are not uncommon. Non-resolving pseudocysts often require surgical intervention. Endoscopic cystogastrostomy is a minimally invasive procedure which is recommended for this condition. We report a large pancreatic pseudocyst in a 4-year old child, which developed following therapy with PEG-Asparaginase for acute lymphoblastic leukemia. It was managed with minimally invasive procedure.
PubMed: 25628993
DOI: No ID Found -
Journal of Surgical Case Reports Aug 2015A pancreatic pseudocyst is a collection of serous fluid in relation to the pancreas following acute pancreatitis. If pancreatography is performed, most pseudocysts will...
A pancreatic pseudocyst is a collection of serous fluid in relation to the pancreas following acute pancreatitis. If pancreatography is performed, most pseudocysts will be found to have a connection with the pancreatic ductal system. Most will resolve spontaneously but clinically significant pseudocysts (∼5%) may require surgical intervention. Surgical (laparoscopic or open) direct drainage of pancreatic pseudocysts into the upper gastrointestinal tract is the mainstay of treatment with the possibility of pancreatic resection if malignancy is suspected. We report a persistent post-traumatic pancreatic pseudocyst of 8-year duration, despite recurrent percutaneous aspiration that was finally managed by a Roux-en-Y drainage.
PubMed: 26260477
DOI: 10.1093/jscr/rjv094 -
Gastrointestinal Endoscopy Clinics of... Apr 2018Pseudocysts evolve from fluid collections and/or disruptions of the pancreatic duct. They may occur secondary to acute pancreatitis, pancreatic trauma, or chronic... (Review)
Review
Pseudocysts evolve from fluid collections and/or disruptions of the pancreatic duct. They may occur secondary to acute pancreatitis, pancreatic trauma, or chronic pancreatitis. Lacking the clinical information, radiologists may inappropriately call a fluid collection or any cystic lesion a pseudocyst. With no clear history of acute pancreatitis or chronic pancreatitis, this is rare. Complications include infection, intracystic hemorrhage, or rupture. Pseudocysts can become painful, especially with chronic pancreatitis, and can cause early satiety and weight loss when their size affects the stomach and bowel. Symptomatic pseudocysts can successfully be drained with via surgical, radiologic, or endoscopic drainage.
Topics: Ascitic Fluid; Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis
PubMed: 29519326
DOI: 10.1016/j.giec.2017.11.001 -
The Surgical Clinics of North America Apr 2001This article reviews the history of and the authors' experience with endoscopic management of pancreatic pseudocysts. Discussion includes pseudocyst enterostomy and... (Review)
Review
This article reviews the history of and the authors' experience with endoscopic management of pancreatic pseudocysts. Discussion includes pseudocyst enterostomy and results, the transpapillary method, complications, endoscopic versus surgical and percutaneous therapy, and drainage of infected pseudocysts and pancreatic necrosis.
Topics: Drainage; Endoscopy, Digestive System; Humans; Pancreatic Pseudocyst
PubMed: 11392427
DOI: 10.1016/s0039-6109(05)70128-6 -
The British Journal of Surgery May 1993Pseudocysts may develop as a complication of acute pancreatitis, chronic pancreatitis or pancreatic trauma. As new methods of imaging provide fuller information on their... (Review)
Review
Pseudocysts may develop as a complication of acute pancreatitis, chronic pancreatitis or pancreatic trauma. As new methods of imaging provide fuller information on their incidence and natural history, important differences are emerging between the pseudocysts of acute and chronic pancreatitis. Traditional surgical approaches to the management of pseudocyst are now being challenged by endoscopic techniques and interventional radiology. In the light of these developments the options available are reviewed and strategies for the modern management of pancreatic pseudocysts are suggested.
Topics: Adolescent; Drainage; Endoscopy; Female; Humans; Middle Aged; Pancreatic Pseudocyst; Remission, Spontaneous; Time Factors
PubMed: 8518891
DOI: 10.1002/bjs.1800800508