1/251. Haemosuccus pancreaticus: a clinical challenge.BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/251. 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 = 3.5keywords = pancreatitis (Clic here for more details about this article) |
3/251. Acute hemorrhage into the peritoneal cavity--a complication of chronic pancreatitis with pseudocyst: a case report from clinical practice.Acute hemorrhage due to a pseudocyst of the pancreas is a dangerous complication of chronic pancreatitis (CP). Without operative treatment, mortality is as high as 90%. Immediate recognition of this complication as well as urgent operative treatment allowing the survival of 70% of patients is imperative. Described is the case of a patient with CP and pseudocyst in which hyperamylasemia and unclarified anemia developed following sudden abdominal pain. The suspicion of hemorrhage into the peritoneal cavity was confirmed by selective visceral angiography showing hemorrhage from the splenic artery in the region of the hilus of the spleen. Operative treatment was successful. During the procedure, a ligature was applied to the hemorrhaging splenic artery and a splenectomy was carried out with 2500 ml of bloody contents being removed from the abdominal cavity. Acute hemorrhage into the peritoneal cavity as a complication of chronic pancreatitis with pseudocyst (CPP) requires immediate identification, confirmation by visceral angiography, and urgent operative treatment.- - - - - - - - - - ranking = 3keywords = pancreatitis (Clic here for more details about this article) |
4/251. Post-traumatic pancreatitis with associated aneurysm of the splenic artery: report of 2 cases and review of the literature.In patients with acute pancreatitis, profuse gastrointestinal bleeding is associated with a high death rate. The cause of such bleeding must be evaluated and the bleeding controlled urgently. aneurysm formation is usually the cause of the bleeding. angiography is needed to make a definitive diagnosis and the bleeding site should be controlled by angiographic embolization if possible. If this fails, aneurysm resection is necessary. Two patients are described. Both had aneurysms of the splenic artery, presenting as massive gastrointestinal bleeding in one patient and bleeding into an associated pseudocyst in the other. They required surgical repair, which was successful in both cases.- - - - - - - - - - ranking = 2.5keywords = pancreatitis (Clic here for more details about this article) |
5/251. Management of pancreatic pseudocysts by endoscopic cystogastrostomy.Open surgical drainage is currently the treatment of choice for pancreatic pseudocysts, but endoscopic transmural drainage is another minimally invasive surgical alternative. In this report, we describe two patients with symptomatic pancreatic pseudocysts treated with endoscopic cystogastrostomy. The first patient, a 15-year-old boy, had an episode of traumatic pancreatitis after abdominal injury from a car accident, and complained of postprandial vomiting and abdominal distention 4 weeks later. A large pancreatic pseudocyst, about 10 cm x 6 cm, was noted. The second patient, a 44-year-old man, had a 1-year history of recurrent alcoholic pancreatitis prior to this admission. He suffered from abdominal distention for several weeks. Sonography revealed a large pancreatic pseudocyst, about 18 cm x 9 cm in size. Both patients underwent successful endoscopic cyst-drainage without recurrence. These cases illustrate that endoscopic transmural drainage provides a minimally invasive and effective approach to the management of pancreatic pseudocysts.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
6/251. Haemosuccus pancreaticus due to mucinous cystadenocarcinoma: the significance of recurrent abdominal pain, hyperamylasaemia and a pancreatic cyst in association with recurrent gastrointestinal bleeding.Haemosuccus pancreaticus is a rare cause of gastrointestinal haemorrhage, and when it presents in otherwise healthy people, can prove difficult to diagnose. The cardinal features are episodic epigastric pain associated with a raised serum amylase and the passage of melaena. Failure to make the connection between recurrent gastrointestinal bleeding and apparently unrelated symptoms attributable to pancreatitis may lead to a significant delay in diagnosis.- - - - - - - - - - ranking = 0.5keywords = pancreatitis (Clic here for more details about this article) |
7/251. Spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis.patients with a visceral aneurysm are at high risk for acute transpapillary, intra-, or retroperitoneal hemorrhage, necessitating either surgical or endovascular therapy. We report an instance of spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis before endovascular treatment could be performed. causality and the literature of spontaneous thrombosis in pseudoaneurysms are discussed.- - - - - - - - - - ranking = 2.5keywords = pancreatitis (Clic here for more details about this article) |
8/251. 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 = 0.5keywords = pancreatitis (Clic here for more details about this article) |
9/251. Management of severe acute pancreatitis with a somatostatin analog in a patient undergoing surgery for dissecting thoracic aneurysm: report of a case.A patient who was admitted to our hospital to undergo surgery for a dissecting thoracic aneurysm suffered preoperatively from severe acute pancreatitis with pancreatic pseudocysts. Computerized tomography (CT) demonstrated the presence of new fluid collection around the cyst with the absence of pancreatic necrosis. He was given a somatostatin analog (sandostatin), which was effective in decreasing the abdominal symptoms, leukocyte counts, and the serum C-reactive/protein level. A CT scan revealed that the pancreatic pseudocyst and peripancreatic fluid collection had disappeared. Although somatostatin has been reported to be ineffective for acute pancreatitis with necrosis, pancreatitis without necrosis may regress after treatment with sandostatin. This is probably due to its suppressive effect on the exocrine function, thus resulting in a decrease of pancreatic juice infiltration.- - - - - - - - - - ranking = 3.5keywords = pancreatitis (Clic here for more details about this article) |
10/251. Laparoscopic cystogastrostomy for pancreatic pseudocyst is safe and effective.Between March 1997 and March 1998, three consecutive patients underwent laparoscopic cystogastrostomy for persistent giant retrogastric pancreatic pseudocyst complicating an attack of acute pancreatitis. The mean cyst diameter was 15 /- 1 cm (range 14-16). The procedure was performed with four trocars. The anterior wall of the stomach was opened longitudinally. The pseudocyst was entered through the posterior wall of the stomach. A cystogastrostomy was created by suturing the margins of the communication by interrupted nonabsorbable sutures. The mean operative time was 123 /- 15 min, and there were no postoperative complications. The mean postoperative hospital stay was 4 /- 1 days. Computed tomography demonstrated complete resolution of the pseudocyst. Laparoscopic cystogastrostomy represents a good therapeutic option for persistent retrogastric pancreatic pseudocyst.- - - - - - - - - - ranking = 0.5keywords = pancreatitis (Clic here for more details about this article) |
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