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World Journal of Gastrointestinal... Sep 2013Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free...
Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography (CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric fistula.The fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.
PubMed: 24044048
DOI: 10.4253/wjge.v5.i9.461 -
Diagnostic Pathology Oct 2013Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass.... (Review)
Review
UNLABELLED
Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.
VIRTUAL SLIDES
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671.
Topics: Adult; Choristoma; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Mediastinal Neoplasms; Pancreatic Cyst; Pancreatic Pseudocyst; Tomography, X-Ray Computed; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 24152726
DOI: 10.1186/1746-1596-8-176 -
International Journal of Surgery Case... 2011Cysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal cysts can however present with severe abdominal pain and can be complicated by...
Cysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal cysts can however present with severe abdominal pain and can be complicated by haemorrhage, rupture or infection. Adrenal pseudocysts appear to result from haemorrhage within a normal adrenal gland and can expand to accommodate massive amounts of fluid.We report the case of a 39-year-old woman who presented with worsening right upper quadrant pain. An ultrasound scan of the abdomen confirmed a large 29 cm × 20 cm × 17 cm cyst that appeared to originate in the upper pole of the right kidney causing displacement of the liver and right kidney.Following complete aspiration the cyst re-accumulated and an MRI scan demonstrated a thickened and irregular cyst wall with haemorrhagic fluid. Laparoscopic right adrenalectomy was performed and the histopathological diagnosis was confirmed as an adrenal pseudocyst.
PubMed: 22096761
DOI: 10.1016/j.ijscr.2011.10.002 -
An asymptomatic huge primary retroperitoneal pseudocyst: a case report and review of the literature.BMC Surgery Feb 2022Retroperitoneal non-pancreatic or idiopathic pseudocysts are very rare lesions. This case report aimed to present our patient and to check all the available literature... (Review)
Review
BACKGROUND
Retroperitoneal non-pancreatic or idiopathic pseudocysts are very rare lesions. This case report aimed to present our patient and to check all the available literature on this kind of rare disease.
CASE PRESENTATION
Our patient was a 67-year-old Iranian man admitted with mild abdominal discomfort for three months. Ultrasonography and CT scan revealed a huge cystic structure within the retroperitoneal space. The lesion was excised through midline laparotomy and opening of the retro-peritoneum. The histopathology of the cyst wall revealed a benign cystic lesion with no epithelial lining. A histologic diagnosis of non-neoplastic retroperitoneal pseudocyst was made.
CONCLUSION
The primary non-pancreatic retroperitoneal pseudocysts are rare lesions and have to be distinguished from other differential diagnoses of retroperitoneal lesions, and a surgeon should be aware of the possible occurrence of these lesions with unknown origin. Surgical excision is the only way to exclude malignancy and confirm the diagnosis.
Topics: Aged; Cysts; Humans; Iran; Laparotomy; Male; Retroperitoneal Space; Ultrasonography
PubMed: 35172808
DOI: 10.1186/s12893-022-01510-5 -
International Journal of Surgery Case... Nov 2021Pseudocysts of the spleen are rare entities with cystic lesions of the spleen being uncommon in general. It is estimated that splenic cysts occur in about 0, 07% of the...
INTRODUCTION AND IMPORTANCE
Pseudocysts of the spleen are rare entities with cystic lesions of the spleen being uncommon in general. It is estimated that splenic cysts occur in about 0, 07% of the population. In general, splenic cystic lesions are discovered incidentally or by mass effect. In the literature, only a limited number of splenic cysts are reported. We report a case of splenic pseudocyst with mass effect where we used laparoscopic fenestration of the pseudocyst with omentopexy as a treatment of choice.
CASE PRESENTATION
The patient is a 62-year-old male with no previous history of trauma. He visited his GP for abdominal pain with flaring towards the left shoulder accompanied by early satiety, occasional obstipation, and breathing difficulties. He was referred to our hospital after enhanced computed tomography showed a 15 × 13 cm splenic cyst with displaced stomach and pancreatic tail medially and left kidney downward. Management options were discussed with the patient and he opted for a laparoscopic approach. In this case, we performed laparoscopic fenestration of the pseudocyst with omentopexy.
CLINICAL DISCUSSION
Until recently splenectomy was the surgical treatment of choice for all large or symptomatic cystic lesions of the spleen however with growing knowledge about the protective role of the spleen an approach with spleen protection is advocated.
CONCLUSION
There are many advantages to the laparoscopic approach of splenic cystic lesions and it may be the treatment of choice for this uncommon surgical problem.
PubMed: 34666251
DOI: 10.1016/j.ijscr.2021.106475 -
Clinics (Sao Paulo, Brazil) 2021Pancreatic pseudocysts (PPC) are fluid collections with a well-defined wall that persist for more than 4 weeks inside or around the pancreas as a result of pancreatic...
OBJECTIVES
Pancreatic pseudocysts (PPC) are fluid collections with a well-defined wall that persist for more than 4 weeks inside or around the pancreas as a result of pancreatic inflammation and/or a ductal lesion. PPC have been successfully treated with endoscopic ultrasound (EUS)-guided drainage using different stents. This study aimed to evaluate the safety and efficacy of EUS-guided drainage of PPC using double-pigtail plastic stents in a tertiary hospital.
METHODS
Patients with PPC referred for EUS-guided drainage between May 2015 and December 2019 were included in this case series. The primary endpoint was to evaluate the efficacy (clinical success) and safety (adverse events and mortality) of EUS-guided drainage of PPC. Secondary endpoints included technical success and pseudocyst recurrence.
RESULTS
Eleven patients (mean age, 44.5±18.98 years) were included in this study. The etiologies for PPC were acute biliary pancreatitis, chronic alcoholic pancreatitis, and blunt abdominal trauma. The mean pseudocyst size was 9.4±2.69 cm. The clinical success rate was 91% (10/11). Adverse events occurred in three of 11 patients (27%). There were no cases of mortality. The technical success rate was 100%. Pseudocyst recurrence was identified in one of 11 patients (9%) at 12 weeks after successful clinical drainage and complete pseudocyst resolution.
CONCLUSION
EUS-guided transmural drainage of PPC using double-pigtail plastic stents is safe and effective with high technical and clinical success rates.
Topics: Adult; Drainage; Endosonography; Humans; Middle Aged; Neoplasm Recurrence, Local; Pancreatic Pseudocyst; Plastics; Retrospective Studies; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 34378728
DOI: 10.6061/clinics/2021/e2701 -
Pediatric Radiology Dec 2019Endoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery.
BACKGROUND
Endoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery.
OBJECTIVE
This study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent.
MATERIALS AND METHODS
We conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening.
RESULTS
Image-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8-47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7-15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children.
CONCLUSION
Pancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.
Topics: Adolescent; Alloys; Child; Child, Preschool; Cohort Studies; Contrast Media; Drainage; Endosonography; Female; Follow-Up Studies; Gastrostomy; Hospitals, Pediatric; Humans; Male; Minimally Invasive Surgical Procedures; Pancreas; Pancreatic Pseudocyst; Retrospective Studies; Risk Assessment; Self Expandable Metallic Stents; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31342130
DOI: 10.1007/s00247-019-04471-9 -
Acta Gastro-enterologica Belgica 2017Pancreatic cystic lesions are being increasingly detected in last years. Pancreatic cysts can be classified grossly into pseudocysts and true cysts. In the true cysts... (Review)
Review
Pancreatic cystic lesions are being increasingly detected in last years. Pancreatic cysts can be classified grossly into pseudocysts and true cysts. In the true cysts group, it is important to distinguish mucinous from non-mucinous cysts because the former are considered being premalignant lesions. In this article the major types of pancreatic cysts are reviewed, with emphasis on the histopathological aspects. Molecular markers in the cyst fluid are being increasingly studied in recent years ; the clinical utility of such biomarkers should be addressed in future studies.
Topics: Cystadenoma, Mucinous; Diagnosis, Differential; Early Detection of Cancer; Humans; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst; Precancerous Conditions
PubMed: 29560696
DOI: No ID Found -
Cureus Nov 2021Pancreatic pseudocyst formation is a common sequela of pancreatitis caused by alcohol use or gallstones. Giant pancreatic pseudocyst is an infrequently reported but...
Pancreatic pseudocyst formation is a common sequela of pancreatitis caused by alcohol use or gallstones. Giant pancreatic pseudocyst is an infrequently reported but serious complication of pancreatitis. Due to the large volume of pancreatic fluid containing active enzymes, giant pancreatic pseudocysts may require surgical intervention. We report a case of a giant pancreatic pseudocyst in a 56-year-old-female with a history of heavy alcohol use presenting with shortness of breath, general malaise, and dyspnea on exertion. Initial computed tomography (CT) scan demonstrated a giant pancreatic pseudocyst measuring up to 22 cm in the largest diameter. The patient was hospitalized, and an endoscopic cystogastrostomy was performed. Once the patient was stabilized, the cystogastrostomy stent was removed and replaced with a pigtail catheter. CT scan at three-month follow-up demonstrated no evidence of fluid re-accumulation. Due to the large size of giant pancreatic pseudocysts, drainage of the pseudocyst is the most appropriate treatment. There are different treatment modalities to achieve the goal of draining pseudocysts. One of the most commonly used treatments is an endoscopic ultrasound-guided cystogastrostomy, which this case highlights as an acceptable treatment option for giant pancreatic pseudocyst.
PubMed: 34987890
DOI: 10.7759/cureus.19990 -
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