Cases reported "Pancreatic Fistula"

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1/10. Communicating bronchopulmonary pancreatic foregut malformation.

    Bronchopulmonary foregut malformations include intralobar and extralobar pulmonary sequestrations, bronchogenic cysts, and communicating bronchopulmonary foregut malformations (CBPFM). These malformations, formes frustes, originate as developmental abnormalities of ventral foregut budding of the tracheobronchial tree or the gastrointestinal tract. The communication's patency with the parent viscus determines if a contained malformation occurs, or if an abnormal communication persists as a CBPFM. This case demonstrates a unique example of a CBPFM in which the main pancreatic duct communicated with pulmonary parenchyma through a retroperitoneal fistula.
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2/10. Pancreaticoportal fistula in association with antiphospholipid syndrome presenting as ascites and portal system thrombosis.

    Fistulous communication between the pancreas and the portal venous system is extremely rare and is usually a complication of chronic pancreatitis or pancreatic pseudocysts. A patient who presented with abdominal pain and ascites secondary to a pancreaticoportal fistula and portal system thrombosis is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and confirmed by immediate postprocedure computed tomographic scanning. Laboratory studies identified concomitant antiphospholipid syndrome. The patient responded favourably to supportive medical therapy.
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3/10. Spontaneous internal drainage of pancreatic pseudocysts.

    Six cases are reported in which spontaneous internal drainage between a pancreatic pseudocyst and the alimentary tract became established. In each instance the communication was demonstrated radiologically. The clinical circumstances and radiographic features of these cases are described, and the existing literature pertaining to this phenomenon is reviewed.
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4/10. Intrapancreatic communication of bile and pancreatic ducts secondary to pancreatic necrosis.

    An unusual complication of acute necrotizing pancreatitis occurred in which erosion of the intrapancreatic common bile duct and cephalic pancreatic duct formed a pancreaticobiliary cavity. This pancreatic process was observed to enhance during contrast computed tomography and was hypervascular during angiography, making preoperative diagnosis difficult. To our knowledge, the spontaneous development of such a cavity as a complication of acute pancreatitis has not been reported. The patient was successfully treated with pancreaticoduodenectomy.
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5/10. Fistulous communication of pseudocyst to the common bile duct: a complication of pancreatitis.

    A pseudocyst developed in a child following acute pancreatitis and spontaneously drained into the common bile duct, a rare occurrence previously described only in adults. The imaging findings are similar to those of a choledochal cyst; serial sonograms enabled diagnosis by documenting evolution of the lesion and should be of value in demonstrating resolution.
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6/10. 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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7/10. Gas in the pancreatic bed without abscess.

    A series of 259 patients from the Emory University Affiliated hospitals with clinical suspicion of pancreatic inflammatory or neoplastic disease was reviewed. Seven of the patients had documented gas in a pancreatic mass; three of the cases were proved subsequently not to be pancreatic abscess formation. Two of the seven patients had proven fistulae from pseudocyst to bowel documented either by surgery or on an associated radiologic examination which accounted for the gas. In one additional patient, no fistula was identified at preoperative radiologic examination or at surgery. The awareness of this entity is important in the avoidance of unnecessary surgery. Since patients with spontaneous cystoenteric fistulae improve after rupture into the gastrointestinal tract, this entity should be kept in mind, particularly in the patient who is not toxic. Radiologic evaluation of the gastrointestinal tract to detect fistulous communication, percutaneous aspiration, and culture may prevent unnecessary surgery.
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8/10. Rapid diagnosis of obstructive jaundice due to pancreatic abscess with pancreaticobiliary fistula.

    A case of pancreatic abscess with pancreaticobiliary fistula manifesting as obstructive jaundice of occult etiology is presented. diagnosis was made preoperatively by skinny needle percutaneous transhepatic cholangiography. In addition, a communication between the biliary tree and the pancreatic abscess cavity was demonstrated in the absence of previous biliary surgery or primary biliary tract disease. We feel this is the procedure of choice for emergency visualization of the biliary tree in a jaundiced patient where a surgically approachable lesion is suspected.
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9/10. Pancreaticocolonic fistula: a complication of pancreatitis.

    In three cases of pancreaticocolonic fistula presenting before the stage of exsanguinating hemorrhage of severe sepsis the problem was diagnosed on the basis of the clinical history, visualization of the terminal part of the fistula by roentgenography after a barium enema had been given and, in two cases, demonstration of the communication with the pancreatic ductal system by endoscopic retrograde pancreatography. The lesions were repaired surgically. Pancreaticocolonic fistula should be suspected in a patient with upper abdominal pain who has a history of abdominal pain and excessive alcohol consumption and in whom diarrhea and fever, hematochezia or a disappearing abdominal mass develops. Characteristically barium will collect in the terminal part of the fistula and thus permit a tentative diagnosis; the diagnosis can then be confirmed by endoscopic retrograde pancreatography. With this approach surgical treatment can be carried out earlier and the often fatal course of the disorder can be averted.
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10/10. Spontaneous communication between a pancreatic pseudocyst and the colon: unusual clinical and radiographic presentation.

    A huge pancreatic pseudocyst which nearly filled the entire abdomen ruptured into the sigmoid colon, and caused perplexing clinical and radiographic findings. Because of the thickness of its wall, the pseudocyst did not collapse but became filled with intestinal gas. The more common features of pseudocysts that rupture are discussed.
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