Cases reported "Pancreatic Diseases"

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1/26. Complete recovery after spontaneous drainage of pancreatic abscess into the stomach.

    Pancreatic abscess is a dreaded complication of acute pancreatitis, with a high death rate even with aggressive surgical treatment. We report two cases in which recovery followed spontaneous drainage into the stomach. A 75-year-old woman with biliary pancreatitis and a 63-year-old man with ethanol-induced pancreatitis both developed pancreatic abscess, diagnosed by computed tomography scans and ultrasound. The spontaneous gastric fistula was heralded by a large emesis of purulent and necrotic material in one case and copious nasogastric tube secretions of a similar material in the other. Defervescence was immediate, and both patients went on to complete recovery without any further interventions. Contrast studies showed the fistulae. It is concluded that in the event that a pancreatic pseudocyst spontaneously drains into the stomach a 'wait and see' policy should be adopted, and a favorable outcome can be expected.
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ranking = 1
keywords = fistula
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2/26. Primary tuberculosis of the pancreas mimicking a pancreatic tumor.

    BACKGROUND: diagnosis of tuberculosis of the pancreas is often missed, and may present to the clinician as a difficult diagnostic problem. methods: We report an extremely rare case of a 35-year-old woman who admitted for acute pain in the right upper quadrant, jaundice, fever 38 degrees C and chills. During the last 8 mo, she developed increasing fatigue and a weight loss of approx 10 kg. RESULTS: Computed tomography (CT) of the abdomen showed a mass in the head of the pancreas, and upper gastrointestinal endoscopy revealed a stenosis of the second part of duodenum and a pancreatico-duodenum fistula. frozen sections by direct trucut needle biopsy raised suspicions of a malignancy, and a Whipple procedure was performed as a radical procedure. The final histopathology revealed a chronic granulomatous lesion with caseating necrosis. mycobacterium of tuberculosis was detected using the polymerase chain reaction-based assay. CONCLUSION: This unusual case emphasizes that in suspected cases of pancreatic carcinoma with an atypical presentation, an attempt should be made to confirm the diagnosis by CT-guided needle biopsy, or by ultrasound endoscopic fine-needle aspiration.
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ranking = 0.5
keywords = fistula
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3/26. Fistula formation complicating pancreatic abscess.

    Internal fistula formation is a rare complication of pancreatic abscess or pseudocyst; a fairly extensive search of the literature has produced only 47 cases. Common factors in the aetiology, presentation and management are discussed, and a further case is reported which demonstrates many features of this unusual condition.
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ranking = 0.5
keywords = fistula
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4/26. Pancreatic ascites in the first year of life.

    A case of pancreatic ascites in a 4-month-old baby girl is reported. To the best of our knowledge only 4 previous cases occurring in the first year of life have been reported in the pediatric literature. In patients with unexplained ascites, amylase determination should be performed on ascitic fluid and serum. The baby was first treated by external drainage and later by internal drainage of the pseudocyst which had formed along the fistula.
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ranking = 0.5
keywords = fistula
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5/26. Laparoscopic spleen-preserving pancreatic tail resection for an intrapancreatic accessory spleen mimicking a nonfunctioning endocrine tumor: report of a case.

    Laparoscopic surgery is now performed for several pancreatic disorders, such as benign tumors of the pancreatic body or tail, which are a good indication for laparoscopic resection. However, the risk of pancreatic fistula after distal pancreatectomy, performed laparoscopically or by open surgery, is a topic of debate. We report the case of a 61-year-old man in whom a routine follow-up computed tomography (CT) scan showed a solid, well-defined mass, 1.5 cm in diameter, in the pancreatic tail. The mass was homogeneously enhanced from the early phase to the super-delayed phase on enhanced CT. We suspected a nonfunctioning endocrine tumor of the pancreas, and surgery was performed laparoscopically. After dissecting the pancreatic tail away from the splenic hilum and the splenic vessels, it was resected using only a linear stapler. The histological diagnosis was an intrapancreatic accessory spleen. The patient was discharged on postoperative day 14, but was readmitted 6 days later because of a pancreatic fistula, which was treated by CT-guided percutaneous drainage.
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ranking = 866.71637061991
keywords = pancreatic fistula, fistula
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6/26. A review of pancreatico-pleural fistula in pancreatitis and its management.

    Pancreatico-pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleural cavity, most commonly from an enlarging pseudocyst. We review the literature on the causes, investigations and treatment of pancreatico-pleural fistulae and compare this with our own experience of the case of a 41 year old man with a left sided pancreatico-pleural fistula associated with pancreatic duct obstruction. The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patient was managed conservatively. However, deterioration in the patients' condition led to an urgent but not emergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreatic duct, with associated pleural fistula for which aggressive surgical intervention was indicated. The patient subsequently completely recovered.
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ranking = 4.5
keywords = fistula
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7/26. Surgical management of a pancreaticopleural fistula in a child with chronic pancreatitis.

    Chronic pancreatitis in children rarely results in the development of a recalcitrant pleural effusion, secondary to a connection between the pleural cavity and the pancreas. We describe such a case and the curative surgical therapy and include a brief discussion of the relevant medical literature as it pertains to this complication in the pediatric population.
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ranking = 2
keywords = fistula
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8/26. Pancreatic calculus impacted at ampulla of vater causing severe cholangitis and septic shock.

    patients with chronic pancreatitis may have varied complications including common bile duct stenosis, cholangitis, pseudocyst or fistula formation and secondary biliary cirrhosis. common bile duct obstruction due to disimpaction of a pancreatic calculus into the ampulla of vater leading to severe cholangitis and septic shock is a rare phenomenon. We are reporting such a case here.
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ranking = 0.5
keywords = fistula
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9/26. Pancreaticopleural fistula: a rare thoracic complication of pancreatic duct disruption.

    Pancreaticopleural fistula resulting in a chronic pleural effusion is a rare complication of pancreatic duct disruption. We describe the presentation and management of 2 children with pancreaticopleural fistulas. Pleural fluid amylase concentration and contrast computed tomography were sufficient to establish the diagnosis in both cases. The initial management of these fistulas should be conservative, by tube thoracostomy and suppression of pancreatic secretion. Operative treatment is necessary for those who fail to resolve. Complete diversion of the pancreatic juice into the gastrointestinal tract by longitudinal pancreaticojejunostomy has been an effective surgical option leading to fistula closure.
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ranking = 4
keywords = fistula
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10/26. Endoscopic treatment of a pancreatic abscess originating from biliary pancreatitis.

    We present a case report of a patient with two large pancreatic abscesses and an associated colonic fistula originating from acute gallstone pancreatitis, which we treated endoscopically. The common bile duct stones were extracted after a papillotomy. The abscess in the pancreatic head was drained into the duodenum and the one in the pancreatic tail irrigated through a nasopancreatic catheter using normal saline mixed with gentamycin. The colonic fistula was finally obliterated using a two-component fibrin glue.
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ranking = 1
keywords = fistula
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