| Bleeding from a pancreatic pseudocyst through the ampulla of vater is a rare cause of overt gastrointestinal haemorrhage. Previously described mechanisms of such haemorrhage are reviewed. We report a case of a 74-year-old female with a pancreatic pseudocyst that bled into the gastrointestinal tract following the administration of heparin. We believe that this is the first reported case of its kind. ( info) |
12/482. 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. ( info) |
13/482. 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. ( info) |
| 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. ( info) |
15/482. 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. ( info) |
16/482. 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. ( info) |
| The successful endoscopic drainage of a posttraumatic pancreatic pseudocyst in a 9-year-old boy is described. This case study suggests that there is a role for endoscopic placement of stents in the treatment of pancreatic pseudocysts in children. ( info) |
| Massive bleeding from a pancreatic pseudocyst is a rare condition that poses a diagnostic and therapeutic challenge. A 36-yr-old woman presented with acute pancreatitis due to gallstones. Twenty-two days later, she developed severe abdominal pain and hypotension. CT scan revealed hemorrhage into a pancreatic pseudocyst and a large amount of free blood in the peritoneal cavity. At laparotomy, 8 L of blood was evacuated from the peritoneal cavity and 14 units of blood were transfused. The gastroduodenal artery was found to be the cause of the bleeding and was undersewn. A pancreatic necrosectomy was performed and the cavity was packed. The packs were removed the following day. Postoperatively, pancreatic collections were aspirated under ultrasound guidance on three occasions. She was discharged 50 days after admission and had an open cholecystectomy 1 month later. She remains well 1 yr after surgery. ( info) |
19/482. Use of disposable stapler in operative cystogastrostomy for pancreatic pseudocyst. surgical stapling techniques are widely used in gastrointestinal surgery. These procedures are excellent in convenience and safety. We describe here a new practical application of the surgical disposable stapler, Auto Suture Premium Plus CEEA 34 circular stapler, for the operative drainage of a large symptomatic pancreatic pseudocyst. A 68 year-old man underwent an operative cystogastrostomy using this instrument. His post-operative recovery was uneventful. He is free from symptoms, and abdominal tomography shows complete disappearance of the cystic cavity. We believe that this is the first clinical paper that reports on the stapled cystogastrostomy. This instrument is very useful for creating a stapled cystogastrostomy, similar to one created in the standard open approach. ( info) |
| pancreatic pseudocyst in the liver is a rare complication of acute or chronic pancreatitis. However, its frequency seems to be increasing with modem imaging procedures. The authors report a case of pancreatic pseudocyst involving the left lobe of the liver that occurred in a patient who never showed clinical evidence of pancreatitis or pancreatic injury. Complete screening led to the discovery of alcoholic chronic pancreatitis. The pseudocyst was treated successfully by radiologic drainage. The pancreatic pseudocyst location and therapeutic approaches are discussed. A literature review uncovered 26 cases of hepatic pancreatic pseudocysts. Clinical presentation, imaging characteristics, and treatment of these cases are analyzed. ( info) |