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Pharmacotherapy Sep 2011A pancreatic pseudocyst is a complication of abdominal trauma in pediatric patients. Octreotide acetate is an effective adjunct therapy used in combination with...
A pancreatic pseudocyst is a complication of abdominal trauma in pediatric patients. Octreotide acetate is an effective adjunct therapy used in combination with traditional surgical approaches. We describe a 19-month-old boy with a pancreatic pseudocyst secondary to blunt abdominal trauma who was successfully managed with octreotide acetate in combination with percutaneous drainage and the placement of a pancreatic stent. Octreotide acetate 1 μg/kg/hour was administered as a continuous intravenous infusion for 24 hours, followed by 2.5 μg/kg/dose every 12 hours subcutaneously for 11 days. The patient was discharged after the pseudocyst had resolved and oral feeding was restored. He had no recurrence of the pseudocyst. The published literature regarding octreotide acetate therapy for pediatric pancreatic pseudocysts is limited. Previously reported cases demonstrated successful resolution of pancreatic pseudocysts with varying doses of intravenous and subcutaneous octreotide acetate within 23-30 days; however, with our patient's regimen, along with surgical interventions, the pseudocyst resolved within 11 days. In addition, our patient's regimen involved higher doses of octreotide acetate given more frequently than those reported in the literature. This case report illustrates that use of higher octreotide acetate dosages may be a potential adjunct therapy to surgical interventions for the management of pancreatic pseudocysts in children.
Topics: Gastrointestinal Agents; Humans; Infant; Male; Octreotide; Pancreatic Pseudocyst; Wounds and Injuries
PubMed: 21923595
DOI: 10.1592/phco.31.9.924 -
World Journal of Gastroenterology Feb 2010Pancreatic pseudocysts, which account for 70%-90% of pancreatic cystic lesions, characteristically are non-epithelially lined cystic cavities that are contiguous with...
Pancreatic pseudocysts, which account for 70%-90% of pancreatic cystic lesions, characteristically are non-epithelially lined cystic cavities that are contiguous with the pancreas. Pancreatic pseudocysts can be caused by acute, chronic or traumatic pancreatitis and should be differentiated from other pancreatic diseases with cystic appearances, especially cystic neoplasms. We report a unique case of a pancreatic pseudocyst filled with semisolid lipids, which appeared by endoscopic ultrasound as a solid mass, and was therefore resected.
Topics: Endosonography; Humans; Lipids; Male; Middle Aged; Pancreatic Pseudocyst
PubMed: 20180247
DOI: 10.3748/wjg.v16.i8.1034 -
Gastroenterology Clinics of North... Sep 1999A better definition of a pseudocyst that clearly separates it from acute fluid collection, improvements in imaging studies, and a better understanding of the natural... (Review)
Review
A better definition of a pseudocyst that clearly separates it from acute fluid collection, improvements in imaging studies, and a better understanding of the natural history of pseudocysts have changed the concepts regarding their management. The old teaching that cysts of more than 6 cm in diameter that have been present for 6 weeks should be drained is no longer true. Indications for drainage are presence of symptoms, enlargement of cyst, complications (infection, hemorrhage, rupture, and obstruction), and suspicion of malignancy. The available forms of therapy include percutaneous drainage, transendoscopic approach, and surgery. The choice of procedure of depends on a number of factors, including the general condition of the patient; size, number, and location of cysts; presence or absence of communication of the cyst with the pancreatic duct; presence or absence of infection; and suspicion of malignancy. Expertise of the radiologist and the endoscopist is also a major deciding factor in the choice of therapy. Percutaneous catheter drainage is safe and effective and should be the treatment of first choice in poor-risk patients, for immature cysts, and for infected pseudocysts. Contraindications include intracystic hemorrhage and presence of pancreatic ascites. For mature cysts, in skilled endoscopic drainage should be given the first preference. It is less invasive, less expensive, and easier to perform with better outcomes in smaller pseudocysts and pancreatic head pseudocysts. Endoscopic expertise is limited, however, and at present endoscopic drainage cannot be advocated as the procedure for general use. In the absence of endoscopic expertise, percutaneous catheter drainage is the procedure of choice. Surgical treatment has been the traditional approach and is still the preferred treatment in most centers. Multiple pseudocysts, giant pseudocysts, presence of other complications related to chronic pancreatitis in addition to pseudocyst, and suspected malignancy are best managed surgically. Surgery is also the backup management in the event that percutaneous or endoscopic drainage fails. Because radiologic diagnosis of pseudocyst may be inaccurate in 20%; it is imperative to be sure that the cystic structure is not a neoplasm before percutaneous or endoscopic drainage. There have been no prospective, randomized trials that have evaluated the results of the three major modalities of therapy (percutaneous, endoscopic, and surgical), and before one can definitely recommend percutaneous drainage or endoscopic approach as the preferred initial mode of therapy, further studies are needed.
Topics: Decision Making; Diagnosis, Differential; Endoscopy, Digestive System; Humans; Pancreatic Pseudocyst; Recurrence; Suction; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
PubMed: 10503140
DOI: 10.1016/s0889-8553(05)70077-7 -
Journal of Gastrointestinal Surgery :... Jan 2006Pancreatic pseudocysts are usually located in the peripancreatic area, but on rare occasion a pseudocyst can reach the mediastinum. The natural history of mediastinal...
Pancreatic pseudocysts are usually located in the peripancreatic area, but on rare occasion a pseudocyst can reach the mediastinum. The natural history of mediastinal pseudocysts is poorly understood and seldom reported in the literature. We treated a patient who presented with an acute airway obstruction from a mediastinal pancreatic pseudocyst. Initial acute airway management and stabilization proved successful. A staged cyst decompression via a cervical and abdominal transhiatal approach was ultimately required. The natural history, potential complications, and management of pancreatic mediastinal pseudocysts are reviewed.
Topics: Airway Obstruction; Female; Humans; Mediastinal Cyst; Middle Aged; Pancreatic Pseudocyst; Pancreatitis; Sphincterotomy, Endoscopic
PubMed: 16368505
DOI: 10.1016/j.gassur.2005.05.009 -
BMC Research Notes Apr 2018Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. A pseudocyst with the major diameter of 10 cm is termed as a...
BACKGROUND
Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. A pseudocyst with the major diameter of 10 cm is termed as a giant cyst. Asymptomatic pseudo-cysts up to 6 cm in diameter can be safely observed and monitored without intervention, but larger and symptomatic pseudocysts require intervention.
CASE PRESENTATION
A 27-year-old Sri Lankan male, with history of heavy alcohol use, presented with progressive abdominal distension following an episode of acute pancreatitis. Contrast enhanced CT scan of the abdomen showed a large multilocular cystic lesion almost occupying the entire abdominal cavity and displacing the liver medially and the right dome of the diaphragm superiorly. The largest locule in the right side measured as 30 cm × 15 cm × 14 cm. Endoscopic ultrasound guided drainage of the cyst was performed. The cyst was entered into with an electrocautery-assisted cystotome and a lumen-opposing metal stent was deployed under fluoroscopic vision followed by dilatation with a 10 mm controlled radial expansion balloon. Repeat endoscopic ultrasound was done a week later due to persistence of the collection and a second stent was inserted. Then 10 French gauge × 10 cm double ended pigtails were inserted through both stents. The cysts were not visualized on subsequent Ultra sound scans. Stent removal was done after 3 weeks, leaving the pigtails insitu. The patient made an uneventful recovery.
CONCLUSION
Giant pancreatic pseudocysts are rare and earlier drainage is recommended before clinical deterioration. Some experts suggest that cystogastrostomy may not be appropriate for the treatment of giant pancreatic pseudocysts and in some instances external drainage of giant pancreatic pseudocysts may be safer than cystogastrostomy. Video-assisted pancreatic necrosectomy with internal drainage and laparoscopic cystogastrostomy were also tried with a good outcome. With our experience we suggest endoscopic guided internal drainage as a possible initial method of management of a giant pseudo cyst. However long-term follow up is needed with repeated imaging and endoscopy. In instances where the primary endoscopic internal drainage fails, surgical procedures may be required as a second line option.
Topics: Adult; Drainage; Endoscopy, Digestive System; Endosonography; Humans; Male; Pancreatic Pseudocyst; Pancreatitis
PubMed: 29703250
DOI: 10.1186/s13104-018-3375-9 -
Journal of Pediatric Surgery Nov 1996Pancreatic pseudocysts have not been reported to occur in the fetus or newborn. The authors report two cases of histologically proven pancreatic pseudocysts in neonates,...
Pancreatic pseudocysts have not been reported to occur in the fetus or newborn. The authors report two cases of histologically proven pancreatic pseudocysts in neonates, which were detected using prenatal ultrasonography. Surgical management included external marsupialization followed by internal drainage in one case, and excision in the other. Both patients ultimately did well. The etiology of these lesions remains unclear.
Topics: Anastomosis, Roux-en-Y; Female; Humans; Infant, Newborn; Male; Pancreatectomy; Pancreatic Pseudocyst; Pregnancy; Ultrasonography, Prenatal
PubMed: 8943130
DOI: 10.1016/s0022-3468(96)90185-2 -
Southern Medical Journal Jul 1992Diagnosis and management of pseudocysts of the pancreas often present difficult clinical problems. We reviewed our 18 patients with pancreatic pseudocysts treated...
Diagnosis and management of pseudocysts of the pancreas often present difficult clinical problems. We reviewed our 18 patients with pancreatic pseudocysts treated between January 1985 and October 1989 to identify criteria for operative and nonoperative management based on size of the lesion on computerized tomography. Diagnostic modalities, etiology, management, and concurrent medical problems were also evaluated. Alcohol (72%) was the most common etiologic agent. Hypertension (39%), peptic ulcer disease (28%), and chronic obstructive pulmonary disease (22%) were the most common associated medical problems. CT scan was the most frequently used (100%) and most accurate (100%) preoperative diagnostic tool. Preoperative ERCP modified the treatment plan in only one patient. All pseudocysts smaller than 3 cm on CT scan were managed nonoperatively, without recurrence (mean follow-up of 3 months). The most commonly performed surgical procedure was cystogastrostomy. External drainage procedures had a higher complication rate (100% vs 14%) and higher recurrence rate (33% vs 0%) than internal drainage procedures. Attempted percutaneous drainage in one patient resulted in recurrence. Pancreatic pseudocysts less than 3 cm in diameter can be safely managed nonoperatively. CT scan remains the diagnostic tool of choice. Preoperative ERCP evaluation is of limited utility and needs further evaluation. Internal drainage procedures provide the best surgical results.
Topics: Adult; Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Male; Middle Aged; Pancreatic Pseudocyst; Recurrence; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 1631688
DOI: No ID Found -
Polski Przeglad Chirurgiczny Feb 2017Postinflammatory pancreatic pseudocysts are one of the most common complications of acute pancreatitis. In most cases, pseudocysts self-absorb in the course of treatment...
Postinflammatory pancreatic pseudocysts are one of the most common complications of acute pancreatitis. In most cases, pseudocysts self-absorb in the course of treatment of pancreatitis. In some patients, pancreatic pseudocysts are symptomatic and cause pain, problems with gastrointestinal transit, and other complications. In such cases, drainage or resection should be performed. Among the invasive methods, mini invasive procedures like endoscopic transmural drainage through the wall of the stomach or duodenum play an important role. For endoscopic transmural drainage, it is necessary that the cyst wall adheres to the stomach or duodenum, making a visible impression. We present a very rare case of infeasibility of endoscopic drainage of a postinflammatory pancreatic pseudocyst, impressing the stomach, due to cyst wall calcifications. A 55-year-old man after acute pancreatitis presented with a 1-year history of epigastric pain and was admitted due to a postinflammatory pseudocyst in the body and tail of pancreas. On admission, blood tests, including CA 19-9 and CEA, were normal. An ultrasound examination revealed a 100-mm pseudocyst in the tail of pancreas, which was confirmed on CT and EUS. Acoustic shadowing caused by cyst wall calcifications made the cyst unavailable to ultrasound assessment and percutaneous drainage. Gastroscopy revealed an impression on the stomach wall from the outside. The patient was scheduled for endoscopic transmural drainage. After insufflation of the stomach, a large mass protruding from the wall was observed. The stomach mucosa was punctured with a cystotome needle knife, and the pancreatic cyst wall was reached. Due to cyst wall calcifications, endoscopic drainage of the cyst was unfeasible. Profuse submucosal bleeding at the puncture site was stopped by placing clips. The patient was scheduled for open surgery, and distal pancreatectomy with splenectomy was performed. The histopathological examination confirmed the initial diagnosis of postinflammatory pancreatic pseudocyst. Endoscopic transmural drainage is a highly effective procedure for treating postinflammatory pancreatic pseudocysts. In some patents, especially with large pseudocysts, pseudocysts with calcified walls, and cysts of primary origin, resection should be performed.
Topics: Calcinosis; Drainage; Endoscopy; Endoscopy, Digestive System; Humans; Male; Middle Aged; Pancreatic Pseudocyst; Treatment Outcome
PubMed: 28522785
DOI: 10.5604/01.3001.0009.6006 -
Journal of Korean Neurosurgical Society Mar 2010Gas pseudocysts are a rare cause of lumbar radiculopathy and most symptomatic gas pseudocysts are found within the confines of the spinal canal. A gas pseudocyst in the...
Gas pseudocysts are a rare cause of lumbar radiculopathy and most symptomatic gas pseudocysts are found within the confines of the spinal canal. A gas pseudocyst in the foramen causing lumbar radiculopathy is very rare. We present a case of a 67-year-old woman suffering from severe pain in the right leg. Computed tomography and magnetic resonance imaging revealed a gas pseudocyst compressing the L2 root at the right L2-3 foramen. The patient underwent cyst excision using the lateral transmuscular approach and her leg pain was improved after the operation.
PubMed: 20379480
DOI: 10.3340/jkns.2010.47.3.232 -
Gut and Liver Jan 2012Autoimmune pancreatitis (AIP) is a benign disorder and a unique form of chronic pancreatitis with several characteristic features. A cystic formation that mimics a...
Autoimmune pancreatitis (AIP) is a benign disorder and a unique form of chronic pancreatitis with several characteristic features. A cystic formation that mimics a pseudocyst is a rare finding. There have been a few reports of AIP complicated by pancreatic cysts. We present a case of AIP with multiple pseudocysts and obstructive jaundice caused by IgG4-associated cholangitis. We initially missed the diagnosis due to the pseudocyst. Based on the computed tomography images, laboratory findings and the therapeutic response to steroids, the case was diagnosed as AIP with pseudocysts and associated cholangiopathy.
PubMed: 22375185
DOI: 10.5009/gnl.2012.6.1.132