Cases reported "Pancreatic Pseudocyst"

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1/23. Haemosuccus pancreaticus: a clinical challenge.

    BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.
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2/23. 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.
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3/23. Internal drainage of pancreatic pseudocysts in children using an endoscopically-placed stent.

    Persistent pseudocysts, which are rare in children, have traditionally been managed by open surgery. We describe two children who presented with large, established pseudocysts of the pancreas. They were successfully treated in the short term by minimally-invasive stent placement to create an internal cyst-gastric communication. This approach merits comparison with open surgical techniques.
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4/23. Intrasplenic pancreatic pseudocyst: a case report.

    An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic tail and the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts.
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5/23. Intrapancreatic duodenal duplication associated with pancreatic pseudocysts.

    A rare case of intrapancreatic duodenal duplication causing pancreatitis is reported. At 2 years of age, the patient presented with a recurrent pancreatic pseudocyst. Intraoperative pancreatogram showed the presence of cystic duodenal duplication in the aberrant lobe of the pancreas communication with the pancreatic duct. Since the resection of the duplication, she has been free from recurrence of pancreatitis. In this case, intraoperative pancreatography was of great value.
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6/23. Mediastinal pancreatic pseudocyst with recurrent pleural effusion. Demonstration by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan.

    Mediastinal pseudocysts of internal pancreatic fistulas are rare as a cause of bilateral pleural effusions even in relapsing pancreatitis. We describe a 38-year-old man with recurrent bilateral pleural effusion as a complication of a pancreatic pseudocyst. Extension of a pancreatic pseudocyst into the posterior mediastinum was clearly identified by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan of the abdomen and chest, and the complication was successfully treated by surgical management. We stress the importance of definite assessment of the communication of pancreatic pseudocyst with mediastinum in patients with pancreatitis who develop recurrent pleural effusions.
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7/23. Successful resolution of a mediastinal pseudocyst and pancreatic pleural effusion by endoscopic nasopancreatic drainage.

    CONTEXT: A mediastinal pseudocyst is an unusual complication of acute and chronic pancreatitis. The ideal form of management is controversial, and various successful therapeutic interventions including surgical resection, internal or external drainage, and non-operative radiological drainage techniques have been described. Successful resolution of a mediastinal pseudocyst with endoscopic transpapillary stent placement has been described in fewer than five cases. CASE REPORT: We report a case of chronic pancreatitis with complete pancreas divisum together with a mediastinal pseudocyst and pancreatic pleural effusion in which magnetic resonance imaging and endoscopic retrograde pancreatography demonstrated communication of the abdominal pseudocyst with the posterior mediastinum through the diaphragmatic hiatus. This case was successfully treated with endoscopic transpapillary nasopancreatic drain placement alone. CONCLUSION: A communicating mediastinal pseudocyst can be successfully treated by endoscopic transpapillary nasopancreatic drainage alone.
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8/23. Mucinous cystic neoplasm in a young male patient.

    A 25-year-old Japanese man was admitted to our hospital with a history of recurrent pancreatitis and a pseudocyst of the pancreas. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed an encapsulated multilocular cystic mass 5 cm in diameter in the pancreatic tail. Endoscopic ultrasonography demonstrated a mural nodule, and endoscopic retrograde pancreatography showed a communication of the lesion with the main pancreatic duct. A neoplastic cystic tumor was suspected, and a resection of the body tail of the pancreas was performed. The lesion was a multilocular cyst having a common fibrous capsule and viscous content. Histologically, the cystic lesion was lined with a single layer of columnar cells with low-grade atypia. Ovarian-type stroma (OS) was confirmed, and it showed positive for antiestrogen receptor and antiprogesteron receptor staining. Based on these findings, the lesion was diagnosed as mucinous cystic neoplasm (MCN), an adenoma that shows extraordinarily high prevalence in women. Further study on the pathogenesis of MCN in male patients should be undertaken to elucidate the process of development.
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9/23. pancreatic pseudocyst in a gastrectomized patient: treatment with internalized endoprosthesis.

    Direct percutaneous drainage of pancreatic pseudocysts in communication with the duct of Wirsung can lead to pancreaticocutaneous fistula. These patients are safely treated with the percutaneous transgastric approach. In a gastrectomized patient who developed a pseudocyst, we percutaneously placed in internal endoprosthesis from the duct of Wirsung to the afferent loop and gastric pouch.
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10/23. Mucinous cystadenoma: pitfalls of differential diagnosis.

    Cystic neoplasms of the pancreas often are difficult to differentiate from pseudocysts. It has been proposed that a history of clinical pancreatitis, elevated serum pancreatic enzymes, elevated cyst fluid amylase, and a communication with the pancreatic duct suggest the diagnosis of a pseudocyst. We report the case of a young woman who presented with a cystic mass in the pancreas and was thought to have a pseudocyst because of the above; at surgery, a mucinous cystadenoma was documented. The pitfalls of differentiating neoplastic cysts of the pancreas from pseudocysts are discussed.
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