Cases reported "Pancreatic Cyst"

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1/16. Cystic tumors of the pancreas. Considerations upon 34 operated cases.

    AIM: To point out the morphologic, clinic and therapeutic aspects of pancreatic cystic tumors. MATERIAL AND METHOD: 34 pancreatic cystic tumors (21 males and 13 females, aged between 21 and 68 years), admitted in the last 15 years were analyzed. They were true cysts in 3 cases (9.9%) and pseudocysts in 31 cases (91.1%), located on the head of the pancreas in 8 cases, on the body in 19, on the tail in 6 and on the body and tail in 1 case. We noticed in the past medical history of the patients with pseudocysts a recent acute pancreatitis attack (26 cases), chronic pancreatitis (4 cases) or a recent abdominal trauma (1 case). The delay between the acute pancreatitis attack and the onset of the pseudocyst varied between 18 days and 2 months. The diagnosis was established by clinical picture (Shefer-Silvis triad), laboratory findings and imaging tests (barium meals, ultrasound test and/or CT test). Thirty cases (27 pseudocysts and 3 true cystic tumors) were operated on: the main surgical procedures were cystogastrostomy (12 cases), cystojejunostomy (6 cases) or cystoduodenostomy (3 cases); we also performed distal pancreatectomy (3 cases), laparostomy or external drainage in 5 cases. RESULTS: We registered 1 death (mortality rate of 3.3%), 2 pancreatic fistulae, 1 pancreatic abscess and 2 recurrences. CONCLUSIONS: 1. The pseudocyst, as an evolutionary complication of acute or chronic pancreatitis, is the most frequent cystic tumor of the pancreas, true pancreatic cysts being extremely rare. 2. The diagnosis is established by clinical pictures, laboratory findings and imaging tests. 3. The treatment is surgical, cystogastrostomy or cystojejunostomy being the main surgical procedures.
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ranking = 1
keywords = pancreatic fistula, fistula
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2/16. pancreatic pseudocyst causing portal vein thrombosis and pancreatico-pleural fistula.

    portal vein thrombosis and pancreatico-pleural fistula are unusual complications of chronic pancreatitis. We describe a patient with chronic alcoholic pancreatitis in whom erosion of the splenic vein led to portal vein thrombosis and to the development of a pancreatico-pleural fistula. We suggest that fistula formation may occur over a considerable time period as the portal vein thrombosis was diagnosed three years before the amylase-rich pleural effusions.
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ranking = 0.0037286845745001
keywords = fistula
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3/16. Thoracic manifestations of internal pancreatic fistulas: report of five cases.

    Thoracic manifestations of internal pancreatic fistulas are rare. During the last 8 yr, we have treated one patient with a mediastinal pseudocyst, three patients with pancreaticopleural fistulas, and one patient with a pancreaticobronchial fistula. Recurrent pleural effusions represent one of the main clinical features in this entity, and can often lead to false diagnoses. Determination of pancreatic enzyme activity, as well as the combination of ultrasonography, computerized tomography, and endoscopic retrograde cholangiopancreatography (ERCP), enable the establishment of the diagnosis. A complete pancreatic evaluation is the rationale for an adequate and efficient therapy which should always aim at a focal assentation.
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ranking = 5.0010653384499
keywords = pancreatic fistula, fistula
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4/16. Aortocystoduodenal fistula: rare complication of pancreatic pseudocyst.

    An upper gastrointestinal tract hemorrhage resulting from an aortocystoduodenal fistula developed in a patient with a pancreatic pseudocyst. The fistula was exposed through a duodenotomy, necrotic material was debrided from the pseudocyst and the aortic wall, the aortic defect was closed primarily, and the pseudocyst was drained through a cystoduodenostomy. The case is discussed as a rare hemorrhagic complication of pancreatic pseudocysts and as an illustration that under certain circumstances of infection in areas where aortic bypass can be difficult to perform, primary vascular repair can be a successful method of managing aortoenteric fistulas.
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ranking = 0.0037286845745001
keywords = fistula
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5/16. Pancreatic duct arteriovenous fistula and the metastatic fat necrosis syndrome.

    This report summarizes the course of a patient with asymptomatic chronic pancreatitis associated with hemorrhage into the pancreatic duct and metastatic fat necrosis. Retrograde cannulation of the pancreatic duct and superior mesenteric arteriography established the presence of a pseudocyst with a pancreatic duct-arteriovenous (DAV) fistula as the cause of the syndrome. ligation of feeder vessels with external drainage of the cyst as the initial surgical procedure stopped the bleeding but failed to prevent recurrence of the pancreatic duct-venous fistula. A pancreaticoduodenectomy with resection of the cyst and fistula was required to arrest destruction of distant tissues. Although serum and urine amylase concentrations were markedly elevated, serum lipase levels were normal throughout the patient's course. Elevation of serum lipase does not seem to be a necessary condition for the development of the metastatic fat necrosis syndrome.
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ranking = 0.0037286845745001
keywords = fistula
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6/16. common bile duct complications of pancreatitis evaluation and treatment.

    Five cases that illustrate the spectrum of biliary complications of pancreatitis and pancreatic pseudocyst are discussed. Obstructive jaundice, hemobilia, and bilious ascites were the major problems in these five patients. Sonography, transhepatic cholangiogram, endoscopic retrograde cholangiopancreatography, operative cholangiography, and arteriography are important in establishing the diagnosis and planning the treatment. Three patients had biliary obstruction caused by chronic pancreatitis, a pancreatic pseudocyst, or both. Two patients had a fistula between the common duct and the pseudocyst. Simple decompression of the pseudocyst was curative for only one patient. Three patients required decompression of the biliary tract, which emphasizes the need for intraoperative cholangiography. One patient required a Whipple operation to control hemorrhage but died in the immediate postoperative period. The operative findings determine the specific procedures for biliary tract decompression and pseudocyst drainage.
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ranking = 0.00053266922492859
keywords = fistula
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7/16. Demonstration of an internal pancreatic fistula by computed tomography.

    The computed tomographic demonstration of a mediastinal pseudocyst communicating with the pancreatic duct in a patient with severe acute pancreatitis is reported. An awareness of this communication was essential in planning the appropriate surgical management.
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ranking = 4
keywords = pancreatic fistula, fistula
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8/16. Pancreaticocolonic fistula: a complication of pancreatic pseudocysts in childhood.

    Two patients had an unusual complication of pancreatitis: pancreaticocolonic fistula, frequently associated with life-threatening gastrointestinal hemorrhage and sepsis. To avoid these complications, early diagnosis is important, but it may be difficult. Treatment consists of external drainage of the pancreatic pseudocyst or abscess and colonic diversion.
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ranking = 0.0026633461246429
keywords = fistula
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9/16. Case report of a pancreatic pseudocyst ruptured into the splenic vein causing extrahepatic portal hypertension.

    In a 42 year old female, a fistula developed between the splenic vein and the pancreatic duct through the cavity of a pseudocyst in the tail of the pancreas and resulted in an extrahepatic portal hypertension. The fistula was visualized by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic portography, then was successfully resected by surgery. The possible etiology of extended obstruction of both splenic and portal veins in chronic pancreatitis with pseudocyst was discussed.
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ranking = 0.0010653384498572
keywords = fistula
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10/16. pancreatic pseudocyst and pancreatico-duodenal fistula diagnosed by endoscopic fistulography.

    To our knowledge, primary endoscopic diagnosis of pancreaticoduodenal fistulae has not so far been reported. The diagnosis is often made radiographically at endoscopic retrograde cholangiopancreatography (ERCP). We report one such case, in which a barium meal x-ray suggested duodenal ulceration, and the endoscopic findings suggested a duodenal diverticulum, the bottom of which could not be clearly defined. Instillation of contrast medium revealed the true fistulous nature of the diverticulum-like defect in the duodenal wall. This patient also had a pancreatic pseudocyst communicating with the fistula through the caudal part of the pancreatic duct, visualized during endoscopic fistulography. The patient did well on conservative treatment without surgical intervention.
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ranking = 0.0031960153495715
keywords = fistula
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