1/78. Rupture of a pancreatic pseudocyst into the portal venous system.Pseudocyst formation is a well-known complication of acute or chronic pancreatitis. We report a case in which pseudocyst ruptured into the splenic and portal veins.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/78. A case of renal artery stenosis secondary to chronic pancreatitis.We report a case of renal artery stenosis most probably secondary to chronic pancreatitis. The patient had a traumatic pancreatic fistula. This was followed by numerous attacks of pancreatitis in the following years. At a relatively young age, he developed hypertension. Examinations revealed a right renal artery stenosis which was successfully treated by a percutaneous angioplasty. This rare complication should be kept in mind as a possible complication of pancreatitis.- - - - - - - - - - ranking = 7keywords = pancreatitis (Clic here for more details about this article) |
3/78. Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography.Pancreaticopleural fistula secondary to chronic pancreatitis is a rare cause of recurrent pleural effusion. The demonstration of the fistula with endoscopic retrograde pancreatography and CT is invasive or limited. We report in two patients the use of magnetic resonance pancreatography as a noninvasive alternative to endoscopic retrograde pancreatography for the diagnosis of pancreaticopleural fistula.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
4/78. A case of eosinophilic pleural effusion induced by pancreatothoracic fistula.A 49-year-old man was admitted for evaluation of a left pleural effusion. Thoracenthesis yielded a hemorrhagic pleural effusion with a high percentage of eosinophils (15.9%). Although there were no significant abdominal signs, serological examinations demonstrated a marked increase of pancreatic enzyme activity. Moreover, abdominal CT demonstrated cystic changes between the tail of the pancreas and the spleen. Accordingly ERP was performed under pressure, and contrast medium draining from the pancreas was observed. Pancreatic pleural effusion in this patient consisted of pancreatic juice retained in the thoracic cavity, which resulted from intrapancreatic fistulation connecting to the thoracic cavity due to a pancreatic cyst caused by chronic pancreatitis. The present report indicates that we should investigate the retention of eosinophilic pleural effusion considering not only the possibility of thoracic disease, but also the possibility of a pleural effusion derived from abdominal diseases.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
5/78. Marked effect of octreotide acetate in a case of pancreatic pleural effusion.A pancreaticopleural effusion is a rare complication of chronic pancreatitis. fasting, a protease inhibitor, and/or a surgical intervention are generally selected for the treatment of the pancreatic effusion. We reported here the case, in which octreotide acetate was effective for resolving pancreatic effusion. A 67-year-old man was admitted with a massive pleural effusion. This effusion contained a high level of amylase. Endoscopic retrograde pancreatography followed by computed tomography revealed a pancreaticopleural fistula. The pleural effusion was not improved by the treatment of the protease inhibitor with total parenteral nutrition and fasting. A pancreatic stent could not be emplaced because the major pancreatic duct was coiled. Administration of octreotide acetate, a long-acting somatostatin analogue, markedly diminished the effusion and closed the pancreaticopleural fistula. Transient eosinophilia of peripheral blood was seen on admission, but the number of eosinophils decreased after the octreotide therapy and normalised when pleural effusion disappeared. octreotide is one of the effective options for the treatment of pancreatic pleural effusion.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
6/78. Biliopancreatic fistulas complicating pancreatic pseudocysts: a report of three cases demonstrated by endoscopic retrograde cholangiopancreatography.Three patients were found to have fistulation of the pancreatic and common bile ducts, complicating chronic pancreatitis in one patient and acute pancreatitis in two patients. Closure of the fistula was achieved with biliary and pancreatic stenting in one patient; the other two patients were treated surgically because endoscopic treatment had failed. The clinical and radiological features of this exceptional complication are presented, with a brief review of the topic.- - - - - - - - - - ranking = 2keywords = pancreatitis (Clic here for more details about this article) |
7/78. Percutaneous embolization of the distal pancreatic duct to treat intractable pancreatic juice fistula.Pseudocysts and post-necrotic collections of the pancreas are sometimes treated by percutaneous drainage. In cases of post-necrotic collection, intractable pancreatic juice fistula is often formed by disruption of the main pancreatic duct in the necrotized region. We radically treated intractable pancreatic juice fistulae by selective cannulation into the distal pancreatic duct via the route for percutaneous drainage of post-necrotic collections to extinguish the exocrine function of the caudal pancreas. We performed this procedure in two patients in whom the major pancreatic duct was damaged at the body of the pancreas, which was extensively necrotic. Although mild symptoms of acute pancreatitis appeared in both patients after the first procedure, they recovered without severe side effects. Neither recurrence of pancreatic juice fistulae nor reduction of the glucose tolerance was caused by removing the exocrine function of the caudal pancreas in either patient 32 and 24 months after treatment, respectively. This method is an effective treatment modality with which to treat intractable pancreatic juice fistulae with damage of the main pancreatic duct.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
8/78. Pancreatocolonic fistula due to severe acute pancreatitis: imaging findings.Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis. The spectrum of colonic complications includes localized ileus with "pseudo-obstruction", obstruction, necrosis, hemorrhage, fistula, and ischemic colitis. We report on a patient who developed pancreatocolonic fistulization in the course of protracted severe acute pancreatitis. Emphasis is made on the computed tomographic and water soluble contrast enema findings.- - - - - - - - - - ranking = 6keywords = pancreatitis (Clic here for more details about this article) |
9/78. Pancreatic pseudocysts complicated by splenic parenchymal involvement: results of operative and percutaneous management.Pancreatic pseudocysts are a common finding in acute and chronic pancreatitis, but most are small and uncomplicated, and do not require treatment. Pseudocysts with splenic parenchymal involvement are uncommon but have the potential for massive hemorrhage. Data on the clinical presentation and optimal treatment of this unusual complication of pseudocysts are lacking. The purpose of this review was to identify the clinical features of pancreatic pseudocysts complicated by splenic parenchymal involvement and to determine the outcome with nonoperative and operative therapy. methods: A retrospective review of the medical records of all patients with pancreatic pseudocysts from December 1984 to January 1999 revealed 238 patients, of whom 14 (6%) had splenic parenchymal involvement. These medical records were reviewed in detail and all pertinent radiographs were reviewed by the authors to confirm splenic parenchymal involvement by a pancreatic pseudocyst. RESULTS: Initial treatment included observation (n = 2), percutaneous drainage (n = 8), and surgery (n = 4). Of the eight patients treated by percutaneous drainage, one died, three required repeated percutaneous drainage, and three required surgical intervention. None of the patients treated primarily by surgery required additional therapy for the pseudocyst. overall, 11 patients had complications of the primary therapy, and 25% of patients treated by surgery had significant hemorrhage. Complications included infection (n = 5), pseudocyst persistence (n = 4), bleeding (n = 2), multisystem organ failure (n = 2), gastric outlet obstruction (n = 1), and splenic rupture (n = 2). CONCLUSIONS: Pancreatic pseudocysts complicated by splenic parenchymal involvement may have life-threatening clinical presentations and respond poorly to percutaneous drainage. Distal pancreatectomy and splenectomy are effective, but the complication rate is high.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
10/78. The first histological demonstration of pancreatic oxidative stress in human acute pancreatitis.Necrotizing acute pancreatitis is associated with an inflammatory explosion involving numerous pro-inflammatory mediator cascades and oxidative stress. Acinar oxygen free radical production aggravates pancreatic tissue damage, and promotes cellular adhesion molecule upregulation resulting in leukocyte adherence and activation. The cerium capture oxygen free radical histochemistry combined with reflectance confocal laser scanning microscopy allows the "in situ" histological demonstration of oxygen free radical formation in live tissues. Here we present a case report, where oxidative stress is demonstrated on a histological level for the first time in human acute pancreatitis. A 44-year-old male patient suffering from acute exacerbation of his chronic pancreatitis developed a pancreato-pleural fistula with amylase-rich left pleural exudate causing respiratory compromise. Subsequent to an urgent thoracic decompression a distal pancreatectomy and splenectomy was performed with the closure of abdomino-thoracic fistula. The postoperative course was uneventful, except for a transient pancreatico-cutaneous fistula, which healed after conservative treatment. To carry out cerium capture oxygen free radical histochemistry the resected pancreas specimen was readily perfused with cerium-chloride solution through the arteries on the resection surface. frozen sections were cut, E-, p-selectin, ICAM and VCAM were labeled by immunofluorescence. The tumor-free margin of an identically treated pancreas carcinoma specimen served as a control. Intrapancreatic oxidative stress and cellular adhesion molecule expression were detected by confocal laser scanning microscopy. Numerous pancreatic acini and neighboring capillaries showed oxygen free radical-derived cerium-perhy-droxide depositions corresponding to strong local oxidative stress. Acinar cytoplasmic reflectance signals suggested xanthine-oxidase as a source of oxygen free radicals. These areas presented considerably increased endothelial p-selectin expression with adherent, oxygen free radical-producing polymorphonuclear leukocytes displaying pericellular cerium-reflectance. Modest ICAM upregulation was noted, e-selectin and VCAM expression was negligible. The control pancreas specimen showed minimal oxidative stress with weak, focal p-selectin expression. The development of deleterious pancreatic oxidative stress was based on indirect evidence in human acute pancreatitis. To the best of our knowledge this is the first report demonstrating persistent intrapancreatic oxidative stress histologically in human acute pancreatitis. We have noted p-selectin overexpression with a preponderance in the areas of acinar oxidative stress.- - - - - - - - - - ranking = 9keywords = pancreatitis (Clic here for more details about this article) |
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