1/29. The development of a pancreatic abscess, suppurative pylethrombosis, and multiple hepatic abscesses after a pancreatojejunostomy for chronic pancreatitis: report of a case.We present herein an autopsy case of 63-year-old Japanese man who died as a result of pancreatic abscess, suppurative pylethrombosis, and multiple liver abscesses that had developed 10 years after a pancreato- and cystojejunostomy with side-to-side anastomosis for chronic pancreatitis. Even after this operation, the patient had continued to consume excessive amounts of alcohol. He had first experienced back pain with leukocytosis 9 years after the operation, which relapsed the following year. Despite percutaneous transhepatic gallbladder drainage, his icterus had deteriorated into hepatic insufficiency. Computed tomographic scans of the abdomen had disclosed multiple liver abscesses. At autopsy, a pancreatic abscess and suppurative pylethrombosis as well as multiple liver abscesses were found. There have been few reported cases of such lethal complications developing after a pancreato- and cystojejunostomy for chronic pancreatitis. As the consumption of alcohol would have exacerbated the chronic pancreatitis, such patients should be strongly advised to abstain from drinking alcohol.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
2/29. A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum.We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy. A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no previous history of pancreatitis, gallstones, drinking, or abdominal injury. An elastic-hard tumor-like resistance was palpable in the upper abdomen. Computed tomography and ultrasound (US) examinations revealed a giant cystic lesion expanding from the pancreas head to the tail. Endoscopic retrograde cholangiopancreatography findings showed a looping pancreatic duct which drained only the head and uncinate process of the pancreas to the main papilla. A US-guided puncture to the cystic lesion revealed that the lesion continued to the main pancreatic duct in the tail of pancreas. The lesion was connected to a small cystic lesion, which was located inside the minor papilla, and ended there. The amylase level in liquid aspirated from the cyst was 37 869 IU/l, and the result of cytological examination of the liquid showed class II. A pancreatico(cysto)jejunostomy was performed, with the diagnosis being pancreas divisum associated with a retention cyst following obstruction of the minor papilla. The histological findings of a specimen from the cyst wall revealed that the wall was a pancreatic duct covered with mildly inflammatory duct epithelium; there was no evidence of neoplasm. The patient is currently well, and a CT examination 2 years after the operation showed disappearance of the cyst and normal appearance of the whole pancreas.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
3/29. Papillary and cystic tumor of the pancreas possibly concealed within a pseudocyst.A 17 year old girl, with a papillary and cystic tumor of the pancreas, probably concealed within a previous post-traumatic pseudocyst of the pancreas is described. At 10 years of age, she had received a drainage procedure for a pancreatic pseudocyst, following a blunt abdominal trauma. The histological examination of the cyst wall did not show an epithelial lining. Seven years after that, she developed anemia and a computer tomography and ultrasonography of abdomen revealed a 10 cm x 9 cm x 8 cm, cystic, multilocular pancreatic mass with solid parts. On operation, a fist-sized, solid and multilocular cystic tumor, located in the body and tail of the pancreas, and infiltrating into the colonic serosa but with no metastasis, was found and completely excised. Histologic and electron microscopic examination revealed the characteristic features of a papillary and cystic tumor of the pancreas. This report suggests that cystic lesions of the pancreas should be carefully checked to decide the best surgical therapy.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
4/29. Mediastinal pancreatic pseudocyst with recurrent pleural effusion. Demonstration by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan.Mediastinal pseudocysts of internal pancreatic fistulas are rare as a cause of bilateral pleural effusions even in relapsing pancreatitis. We describe a 38-year-old man with recurrent bilateral pleural effusion as a complication of a pancreatic pseudocyst. Extension of a pancreatic pseudocyst into the posterior mediastinum was clearly identified by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan of the abdomen and chest, and the complication was successfully treated by surgical management. We stress the importance of definite assessment of the communication of pancreatic pseudocyst with mediastinum in patients with pancreatitis who develop recurrent pleural effusions.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
5/29. pancreatic pseudocyst observed on F-18 FDG PET imaging.A 72-year-old man with right lower lobe squamous cell carcinoma of the lung-status, post resection-and prostate carcinoma was referred for restaging with whole-body PET using F-18 FDG. PET images, in addition to the presence of moderate hypermetabolic activity seen in the left lower paratracheal and bilateral hilar regions, revealed a large hypometabolic space-occupying lesion in the abdomen. The appearance of this lesion was highly suggestive of a pancreatic pseudocyst. Further review of a CT scan performed 3 years ago confirmed the presence of a pancreatic pseudocyst. However, this information was not available to the nuclear medicine physician at the time of the PET examination.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
6/29. Laparaoscopic cytogastrostomy for a giant pseudocyst of pancreas.BACKGROUND: Conventionally, a large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus such as stomach, duodenum or jejunum. Recently, the various minimal invasive approaches have been used to treat this condition. Depending on the expertise available, the cyst can be also be drained endoscopically or laparoscopically. We present a case of a large pseudocyst treated laparoscopically. METHOD: A 60-year-old lady was admitted for an elective laparoscopic cholecystectomy as a day case. Under general anaesthesia during her elective laparoscopic cholecystectomy a mass was visible and palpable in the left upper abdomen. Post-operatively, a CT scan of abdomen confirmed the presence of a giant pseudocyst of the pancreas. She successfully underwent a laparoscopic cystogastrostomy four weeks later. CONCLUSION: Laparoscopic cystogastrostomy for pseudocyst of the pancreas is safe, feasible and with good outcome.- - - - - - - - - - ranking = 2keywords = abdomen (Clic here for more details about this article) |
7/29. Acute deterioration of a woman following acute pancreatitis with pseudocysts.BACKGROUND: A 49-year-old white female with a history of acute pancreatitis that was complicated by pseudocysts presented with severe acute-onset abdominal pain of a few hours duration with associated vomiting. physical examination showed a soft abdomen with mild diffuse tenderness and positive bowel sounds. Initial blood work revealed a drop in her hematocrit, and elevated but stable amylase and lipase levels. A CT scan of the abdomen revealed a splenic artery pseudoaneurysm with extravasation of contrast medium into an adjacent pseudocyst. INVESTIGATIONS: physical examination, blood analysis and a CT scan of the abdomen with contrast medium. diagnosis: splenic artery pseudoaneurysm bleeding into an adjacent pseudocyst. MANAGEMENT: Embolization of the splenic artery across the neck of the pseudoaneurysm.- - - - - - - - - - ranking = 3keywords = abdomen (Clic here for more details about this article) |
8/29. pancreatic pseudocyst bleeding associated with massive intraperitoneal hemorrhage.BACKGROUND: pancreatic pseudocyst bleeding is an unusual entity of acute abdomen, usually occurring among alcoholics. A high mortality developed in patients with conservative treatment of hemorrhagic pancreatic pseudocyst. We report a 37-year-old male with a pseudoaneurysm in the tail of the pancreas presenting with sudden onset of abdominal pain and swelling. Emergency laparotomy after blood transfusion and fluid resuscitation was successfully performed. methods: An abdominal radiography showed multiple calcifications in the epigastric area. Computed tomography of the abdomen showed a cystic lesion with a calcified wall in the tail of the pancreas and a large amount of ascites. After contrast enhancement, there was hemorrhage into the pancreatic pseudocyst with extravasation of contrast into the peritoneal cavity. RESULTS: At operation, active bleeding was noted from a ruptured pseudocyst in the tail of the pancreas and ligation of the bleeding vessel was done. CONCLUSIONS: hemorrhage into the pancreatic pseudocyst associated with intraperitoneal bleeding is a potentially life threatening condition. Emergency surgical treatment should be carried out as soon as possible.- - - - - - - - - - ranking = 2keywords = abdomen (Clic here for more details about this article) |
9/29. Mediastinal pseudocyst with pericardial effusion and dysphagia treated by endoscopic drainage.CONTEXT: Pancreatic pseudocysts located in the mediastinum are rare. Symptomatic mediastinal pseudocysts can present with dysphagia, dyspnea, airway obstruction and/or cardiac tamponade. Generally, the standard approaches are surgery and external drainage. Recently, there have been many reports of successful endoscopic drainage mainly using a transpapillary technique. However, there have only been a handful of reports involving successful transmural drainage of mediastinal pseudocysts. CASE REPORT: We report a case of a mediastinal pseudocyst developed after a severe blunt trauma. The patient presented with orthopnea and dysphagia. Multidetector computerized scanning of the abdomen and thorax revealed a thin, cystic, low-attenuation mass in the posterior mediastinum associated with compression of the esophagus and significant pericardial effusion. An endoscopic retrograde pancreatogram demonstrated a normal size pancreatic duct with an extravasation of contrast from the tail of the pancreas into the cyst. Ultimately, the cyst was successfully drained trough gastric fundus. CONCLUSION: Symptomatic mediastinal pseudocysts communicating with the pericardial sac can be successfully drained using a transmural endoscopic approach without the need for surgery or external drainage.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
10/29. Mediastinal pancreatic pseudocysts in children.Mediastinal pseudocyst is an unusual complication of pancreatitis, with only four cases previously reported in children. The extent of the pseudocyst can be defined by computed tomography or magnetic resonance imaging scan and preoperative aspiration of cyst fluid for amylase level can establish the diagnosis. Endoscopic retrograde cholangiopancreatography to define ductal anatomy can help plan the appropriate drainage procedure. Although exceedingly rare, the diagnosis of pseudocyst should be considered for any cystic mass in the abdomen or thorax, even in the absence of elevated amylase or history suggesting pancreatitis.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
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