1/11. Pancreatic pseudocystportal vein fistula manifests as residivating oligoarthritis, subcutaneous, bursal and osseal necrosis: a case report and review of literature.Pseudocyst is a common complication of pancreatitis. Pseudocyst may rupture into the surrounding organs. rupture into the portomesenteric vein is extremely rare with only seven cases being described in the English literature. pancreatic portal vein fistula is very difficult to verify. The aim of this study was to view the diagnostic methods of pancreatic portal vein fistula and to describe the results of high-dose corticosteroid treatment to our knowledge for the first time. We report here a case of pancreatic portomesenteric vein fistula that was manifest as subcutaneous fat necrosis, bursal necrosis, intramedullary aseptic bone necrosis and recidivating oligoarthritis. The literature of this unusual complication is reviewed. The results of high-dose corticosteroid treatment are also described. In patients with recidivating oligoarthritis, subcutaneous, bursal or osseal necrosis a pancreatic process should be included in the differential diagnosis even in cases of no abdominal signs or symptoms or previous abdominal history. Operative exploration of the pancreas should be performed in the early phase of the disease. To diminish the ongoing extrapancreatic manifestations after the closure of the fistula massive corticosteroid treatment may be attempted although the role of this therapy remains controversial.- - - - - - - - - - ranking = 1keywords = subcutaneous fat, fat (Clic here for more details about this article) |
2/11. Pancreatico-mediastinal fistula with a mediastinal mass lesion demonstrated by MR imaging.Internal pancreatic fistulas are uncommon but well-recognized complications of inflammatory pancreatic disease. A case of a pancreatico-mediastinal fistula with a mediastinal mass lesion in a patient with a documented history of chronic alcohol consumption and previous episodes of acute pancreatitis is described. Since the clinical symptomatology was dominated by pulmonary complaints, magnetic resonance (MR) imaging using a breathhold coronal T2-weighted sequence with spectral fat saturation was essential in clarifying this difficult and rare pathology. Furthermore, the depiction of a fistulous tract between a mediastinal mass lesion and the retroperitoneum posterior to the pancreas, i.e., a pancreatico-mediastinal fistula by MR imaging has not been previously reported, to the best of our knowledge.- - - - - - - - - - ranking = 0.0030232005965697keywords = fat (Clic here for more details about this article) |
3/11. Pancreatic-portal vein fistula with disseminated fat necrosis treated by pancreaticoduodenectomy.I have reported the case of a 62-year-old man with chronic alcoholic pancreatitis and a rare pseudocyst-portal vein fistula. Even though he experienced no abdominal symptoms, he had severe metastatic fat necrosis manifested as subcutaneous fat necrosis, polyarthritis, medullary bone necrosis, and mental status changes. Remote tissue destruction continued until relief was gained by pancreaticoduodenectomy and repair of the necrotic portal vein. Disseminated fat necrosis is a rare syndrome that can be the only presenting feature in patients with pancreatitis and pancreatic cancer. Early recognition and treatment of the underlying pancreatic disease may decrease the high morality rate associated with this syndrome.- - - - - - - - - - ranking = 1.0181392035794keywords = subcutaneous fat, fat (Clic here for more details about this article) |
4/11. Pancreatic duct-portal vein fistula.We describe a case of pancreatic duct-portal vein fistula discovered by endoscopic retrograde cholangiopancreatography, with confirmatory computed tomography and angiographic studies. The fistula was associated with chronic pancreatitis that was complicated by recurrent gram-negative bacteremia and peripheral subcutaneous fat necrosis, although pancreatic pseudocyst was not present. Even though surgical treatment was recommended, medical complications precluded surgery and the patient recovered with supportive therapy only. Follow-up endoscopic retrograde cholangiopancreatography showed spontaneous closure of the fistulous connection.- - - - - - - - - - ranking = 1keywords = subcutaneous fat, fat (Clic here for more details about this article) |
5/11. Traumatic pancreatic cutaneous fistula: comparison of enteral and parenteral feedings.A patient with a gunshot injury to the duct of Wirsung in the pancreatic head developed a high-output pancreatic cutaneous fistula. Before operative repair, a 2-month period of nutritional support permitted a comparison of different feeding regimes. Elemental jejunal feedings containing 1-amino acids in a low-fat, hyperosmolar formula were associated with no greater fistula volume output than total parenteral nutrition. In addition to this efficacy in controlling pancreatic exocrine activity, elemental jejunal feedings were less than a third as expensive as parenteral nutrition.- - - - - - - - - - ranking = 0.0030232005965697keywords = fat (Clic here for more details about this article) |
6/11. 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.- - - - - - - - - - ranking = 0.018139203579418keywords = fat (Clic here for more details about this article) |
7/11. The effect of intravenous fat emulsions in patients with pancreatic fistula.Three patients with pancreatic fistulae were given parenteral 10% fat emulsion (Intralipid) to study the effect of intravenous fat on pancreatic fistula output. Each patient received nutritional support with isovolumetric, isonitrogenous, and isocaloric solutions containing either hypertonic dextrose and amino acids, or hypertonic dextrose, amino acids, and a fat emulsion. Measurements of fistula volume, fistula amylase, lipase, and chloride concentrations, and fistula trypsin activity were performed. The patients were studied for periods of 10 to 26 days. No significant increases in any of the above parameters were noted during the periods when the fat emulsions were infused. In one patient the fistula closed spontaneously. We conclude that intravenous fat emulsions may be used to provide nutritional support for patients with pancreatic fistula without increasing pancreatic juice volume or enzyme content.- - - - - - - - - - ranking = 0.027208805369128keywords = fat (Clic here for more details about this article) |
8/11. Chronic pancreaticopleural fistulas.We report two cases of chronic pancreaticopleural fistulas occurring in chronic pancreatitis. In both cases the primary clinical manifestation was a recurrent left pleural effusion with a high content of pancreatic amylase. The pleural effusion was associated with subcutaneous fat necrotic lesions in one patient, and with expectoration of an amylase-rich fluid in the other. Endoscopic retrograde cholangiopancreatography is important because this examination allows a precise evaluation of the ductal morphology and is indispensable to the surgical procedure. We recommend surgical treatment when the fistula does not close spontaneously within two weeks. Both patients were successfully treated by surgery.- - - - - - - - - - ranking = 1keywords = subcutaneous fat, fat (Clic here for more details about this article) |
9/11. Pancreatic exocrine response to parenteral nutrition.Animal experimental data concerning pancreatic exocrine secretory response to parenteral nutrition is contradictory. We have studied the pancreatic exocrine output in a patient with a pure pancreatic fistula. In this patient, parenteral nutrition with hypertonic glucose, amino acids and fat emulsion was not associated with increases in fistula volume or protein output. Enteral protein and fat in this patient caused rapid increases in both fistula volume and protein output. This study supports the use of parenteral nutrition as a means of maintaining the pancreas at rest.- - - - - - - - - - ranking = 0.0060464011931395keywords = fat (Clic here for more details about this article) |
10/11. 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.- - - - - - - - - - ranking = 0.0030232005965697keywords = fat (Clic here for more details about this article) |
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